Photo on Pexels by Polina Tankilevitch
By Lisa Profera MD
It’s well established that cytokine storms are a very important aspect of the morbidity and mortality associated with COVID-19. A cytokine storm is a hyper-inflammatory response to a viral infection, which can evolve into ARDS (Adult Respiratory Distress Syndrome), lung fibrosis, coagulopathy, and death. Cytokine storm syndrome (CS) is a result of the “overreaction” of an infected person’s immune system.
Cytokines are specialized proteins that modulate the immune response to an infectious threat. The most important cytokines are TNF-alpha (Tumor Necrosis Factor Alpha) and IL-6 (Interleukin-6). TNF-alpha binds to cellular receptors, affecting the migration of white blood cells that are “mobilizing the troops” to fight inflammation. Sometimes there is collateral damage, or “friendly fire,” leading to tissue damage and cell death. TNF activation also invites IL-6 and other cytokines to come into play, setting the stage for more inflammation and autoimmune attacks on healthy cells and tissues. This cascade of events is not unique to COVID; it has been observed with other coronaviruses (SARS and MERS) as well as influenza viruses.
Once triggered, the storm can be halted or slowed by down-regulating the release of more cytokines. If we can block TNF and IL-6 cascades, we can effectively prevent ARDS and severe lung damage. The identification and development of new “anti-cytokine storm” and anti-fibrosis agents would provide highly effective weapons in the fight to defeat COVID.
It has been proposed that Cannabis sativa L. can aid in the downregulation of these cytokines; but not all cultivars are beneficial. Some types of cannabis that have been studied have no effect, and others may be even harmful. In this context, it’s imperative to choose your cannabis wisely.
We know that cannabis has many beneficial anti-inflammatory properties. If we could discern which components of this amazing medicinal plant can be used to quell the cytokine storm, we would have some pretty powerful medicine. Recently, Canadian researchers set out to do just that. They screened 200 extracts of cannabis cultivars and found seven that showed potential using a human tissue model. Some of these extracts demonstrated the ability to downregulate pro-inflammatory cytokines and the production of pro-fibrotic proteins. One of the cultivars had the opposite effect—enhancing inflammation.
It’s not just about THC and CBD; the other components of the cannabis plant (minor cannabinoids and terpenes) are also important. All of these components work together in what is known as the “Entourage Effect.” One of best terpenes for fighting inflammation cited in this study is beta-caryophyllene (not a surprise to me!). I’ve referred to this terpene before in prior articles—it can be 30 to 50 times more potent than hydrocortisone. It’s found not only in cannabis, but in other plants such as clove, oregano, cinnamon, and more.
Another study (published in Lancet in April 2020) illustrated the “urgent need” to conduct clinical trials on anti-TNF agents. There are a couple of anti-IL-6 drugs on the market (approved for the treatment of rheumatoid arthritis), but they’re very expensive and may cause serious side effects including bowel perforation, liver toxicity, overwhelming infection, and cancer. Interestingly, RA patients taking these types of medications seemed to be protected from severe COVID disease.
Conversely, cannabis products are categorized as GRAS (Generally Regarded as Safe), just like many vitamins, supplements, and essential oils. The combination of CBD and certain terpenes was recently found to be two times more anti-inflammatory than dexamethasone (preliminary results published in Forbes, July 2020).
This is the first of hopefully many studies that demonstrates the profound anti-inflammatory effects of certain cannabis cultivars as they relate to suppressing cytokine storms. The above-mentioned Canadian study used a 3-D human skin tissue model. More studies need to be carried out using other tissue models of inflammation and lung cell lines. The authors of this study propose that it be used as a “roadmap” for future research. I find this to be very exciting—this is a promising natural avenue (or detour) to subverting a very serious disease.
As my readers know, I’ve been helping people with medical marijuana for about six years. Chronic pain, anxiety, mood disturbance, and poor sleep are the most common issues that can be ameliorated with cannabis. I work closely with a local dispensary called Apothecare Ann Arbor; they were the first growers of certified organic marijuana in the state of Michigan. By using living soil and clean, sustainable growing practices, the quality of the flower produced with its rich terpene profile is unparalleled. This is whole-plant medicine at its best!
Lisa Profera MD
Owner and Founder of PROJUVU MD
Aesthetics and Lifestyle Medicine in Ann Arbor, MI
Medical Director, Facial Innovations Medi-spa, Ann Arbor
Medical Director, Northville Beauty Spa
Certified Medical Marijuana Doctor
Certified doTERRA Essential Oils Expert
BEMER Independent Distributor
CrossFit® Level 1 Trainer
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