Question: Hi, Uwe and all; my question concerns Stem Cell treatment. I have a woman asking to see me (Cannabis Nurse) for surgical back pain relief, though she said she has recently had Stem Cell Therapy, and they told her not to use any anti-inflammatories. CBD, CBDA, CBG, and most other cannabinoids have anti-inflammatory properties. Have you dealt with or found anything on this topic? Thank you, Melynda Ruckels, RN MSN MSMCT candidate.
Answer: Thanks so much for your inquiry. This is a complex topic. Please remember that I’m not a physician and cannot give medical advice. However, I’d happily discuss some relevant findings in the more recent scientific literature that you may find instructive in this context.
Yes, in general, there is plenty of evidence that various cannabinoids, such as CBD and THC, are immunomodulators and, as such, influence the inflammatory process. More specifically, for example, CBD is an anti-inflammatory and immunosuppressive cannabinoid.
At the heart of the issue is that research has shown that certain anti-inflammatory drugs (i.e., NSAIDs) reduce the therapeutic effects of stem cell therapy. As such, it is logical to wonder if anti-inflammatory cannabis constituents similarly inhibit the therapeutic potential of stem cell therapy.
Before we delve in, I wanted to briefly separate the focus of this discussion on adult musculoskeletal issues from trials that look at the impact of cannabinoids on human neural stem cells in the fetus or those exploring the underlying pathology of graft vs. host disease (GVHD). Briefly, and for those interested, data published by the FDA suggest that cannabinoids negatively impact fetal development. Regarding GVHD, data reveals that CB2 agonism may play a critical role in preventing GVHD (Cheng Yin Yuan et al., 2021) and that the use of CBD 300mg p.o. may represent a novel, safe and effective treatment strategy to prevent GVHD (M. Yeshurun et al., 2015).
Now, let’s look at recent and relevant trials to see what we may learn to address your concerns, i.e., using cannabis therapeutics for a patient who received stem cell therapy and who is looking to treat her pain associated with back surgery without interfering with the stem cell treatment.
A trial conducted by German scientists (E. Schmuhl et al., 2014) discovered that CBD promotes the migration of mesenchymal stem cells (MSCs) via CB2 and antagonism at GPR55 in a time and dose-dependent manner. It also induces osteoblastic differentiation, which is potentially relevant to supporting bone regeneration.
In this later laboratory experiment (Miller et al., 2020), data further revealed that stem cells primed with CBD at either low or higher dosages [i.e., low CBD (300 nM) or high CBD (3 mM)] enhance several regeneration parameters, suggesting improvements in stem cell-based therapy with potential relevance to the management of complex wounds after reconstructive surgeries.
Here is another laboratory trial (Miller et al., 2021) in which researchers used CBD and THC to prime stem cells to see if it would enhance their regenerative abilities. Data showed that both THC and CBD, especially at lower dosages (300nM), enhance several regenerative parameters, suggesting that these major cannabis constituents may improve stem cell-based therapies. However, another earlier experiment found that THC had a negative impact on mesenchymal stem cell survival and osteogenesis (A. Gowran et al., 2013).
This trial offers additional insight (Wanhao Yan et al., 2022): CB1 is a potential target for enhancing bone regeneration under inflammatory conditions. THC is a moderate agonist at CB1.
CBDA does not appear in the scientific literature in this context. However, one trial suggests that CBG (CBD, CBDA, CBGA, and THCV) may promote the viability and function of stem cells (T. Fellous et al., 2020). Another experiment you may want to check out found that CBD and CBG showed efficacy against glioblastoma stem cells via activation of TRPV1 and GPR55 (T. Lah et al., 2022).
Another practical aspect that may be of value in this case is considering the form of your cannabis-based remedy—especially systemic relief vs. topical relief. You could apply a topical to cover a relatively small surface area of the affected tissue, void of systemic effects. A tincture or inhalation-based product may be preferred if systemic effect is preferred. Also, remember that merely heating a topical oil, for example, significantly increases the local effects, potentially providing effective analgesic effects. However, it is important to remember, especially when using heated oils, that the larger the surface area you are treating, the higher the chances of inducing systemic effects, which the patient may or may not want to avoid.
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