“An estimated 22 million adults use marijuana in the USA. The role of marijuana in the progression of hepatic fibrosis remains unclear.
Category Archives: Liver Disease
Cannabis in liver disorders: a friend or a foe?
“The recent legalization of recreational marijuana use in some parts of the world, the discovery of new indications for the clinical application of cannabis, and the acceptance of the use of cannabis in practice has been paralleled by extensive research on the active components of cannabis and the endocannabinoid system within the human body.
In this review, we evaluate the available evidence on cannabis and its constituents and the application of this evidence in clinical practice, focusing particularly on the liver and liver diseases.
Constituents of cannabis, such as cannabidiol and Δ-tetrahydrocannabinol, have shown anti-inflammatory, antioxidant, and hepatoprotective effects both in in vitro and clinical studies, and appear to have potential in the symptom management and treatment of various liver diseases that were previously considered difficult to manage conservatively.
In addition, the manipulation of the inherent endocannabinoid response system has found favor in many clinical fields and has generated considerable research and clinical interest. Moreover, evidence with regard to the adverse effects of marijuana use in liver diseases is weak, which has led to raise a question on the prior rules, with regard to a denial of liver transplantation to marijuana users.
All in all, the recent trends in research, clinical experiences, as well as the legislature, has opened up new avenues towards the widespread clinical application of cannabis and its derivatives as well as modifiers of the components of the endocannabinoid system. More research is required to fully exploit these new evidences.”
https://www.ncbi.nlm.nih.gov/pubmed/30169449
https://insights.ovid.com/crossref?an=00042737-900000000-97980
Cannabinoids and reduced risk of hepatic steatosis in HIV-HCV co-infection: paving the way for future clinical research
“Whether or not cannabis itself or cannabinoids contained in it may help to reduce hepatic steatosis in HIV-HCV coinfected patients remains an open question. The existing body of knowledge on the interactions between cannabis and the liver suggest a protective effect of cannabinoids on insulin resistance, diabetes, and NAFLD in the general population. Clinical research with randomized study designs is needed to evaluate the efficacy and safety of cannabis-based pharmacotherapies in HIV-HCV coinfected patients. Targeting the endocannabinoid system seems essential to differently manage several pathological conditions such as intestinal inflammation, obesity, diabetes and fatty liver disease. However, to date, few drugs have been tested in clinical trials. CB1-antagonists and CB2 agonists appear to be viable therapeutic options that need to be explored for the management of liver diseases. As HCV cure rates are coming close to 100% in the era of direct-acting antivirals, it is especially important to be able to identify modifiable risk factors of complications and death in HIV-HCV coinfected patients, as well as possible levers for intervention. Given the persistence of metabolic risk factors after HCV eradication, cannabis-based therapies need to be evaluated both as preventive and therapeutic tools in patients living with or at risk of liver steatosis, possibly in combination with existing conventional approaches.” https://www.tandfonline.com/doi/full/10.1080/14787210.2018.1473764]]>
Long-Term Heavy Recreational Cannabis Use and Serum Delta-9-Tetrahydrocannabinol Levels are not Associated with an Impaired Liver Function in Cannabis Dependents.
“To shed more light on the influence of chronic cannabis use on liver function, we performed a post-hoc analysis of routine lab data of 42 inpatient treatment-seeking (9 female, median: 27 years old) pure cannabis dependents. Serum liver function tests (LFT: transaminases, bilirubin), C-reactive protein (CRP), carbohydrate-deficient transferrin (CDT), and body mass index (BMI) were considered. The LFT were correlated with CDT, BMI, and cannabis-related clinical data (CR); i.e., the serum levels of delta-9-tetrahydrocannabinol (THC) and its major metabolites 11-hydroxy-delta-9-tetrahydrocannabinol (THC-OH) and 11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid (THC-COOH), plus the cannabis-history data. The LFT was normal in 32 (76.2%) patients. There was no significant association of LFT with BMI, CRP, CDT, and CR. No significant differences were found between the group with elevated LFT (N = 10) and the group without elevated LFT (N = 32) regarding BMI, CRP, CDT, and CR, except for THC-OH, which was even lower in the elevated-LFT group. These results argue against a relevant harmful impact of chronic cannabis inhalation on the liver function of relatively healthy humans (apart from nicotine dependence). Specifically, the liver function tests were not significantly influenced by THC and THC-COOH levels, both objective markers for the amount and duration of prior cannabis use.”
https://www.ncbi.nlm.nih.gov/pubmed/30052163
https://www.tandfonline.com/doi/abs/10.1080/02791072.2018.1482031?journalCode=ujpd20
“Nonalcoholic fatty liver disease (NAFLD) is comprised of nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH). It is defined by histologic or radiographic evidence of steatosis in the absence of alternative etiologies, including significant alcohol consumption, steatogenic medication use, or hereditary disorders.
NAFLD is now the most common liver disease, and when NASH is present it can progress to fibrosis and hepatocellular carcinoma. Different mechanisms have been identified as contributors to the physiology of NAFLD; insulin resistance and related metabolic derangements have been the hallmark of physiology associated with NAFLD.
The mainstay of treatment has classically involved lifestyle modifications focused on the reduction of insulin resistance. However, emerging evidence suggests that the endocannabinoid system and its associated