Can Cannabis Heal Diabetic Ulcers?
Cannabis is uniquely able to stop the cycle of inflammation and tissue destruction that leads to diabetic ulcers.
Foot ulcers affect approximately 25% of diabetic patients. These are a particular health burden because they are resistant to conventional therapy. Invasive treatments are expensive, while the non-invasive ones are simply ineffective. The reason for these ulcers arise from a constellation of internal and external factors. However, poor wound healing on the molecular level is largely attributed to chronic inflammation.
Could the anti-inflammatory abilities of cannabis oil be exploited for treatment of diabetic foot ulcers? New evidence is emerging that may support this idea and encourage research teams toward research in this area.
It is known that immune cells express CB1 and CB2 receptors, and are capable of synthesizing, transporting and catabolizing cannabinoids. Studies on mice have shown that when the enzyme that normally breaks down the endocannabinoid, “anandamide” is elevated, the inflammatory response was reduced. This suggests that indeed, endocannabinoids are capable of modulating the immune response. It is the activation of the immune inflammatory response that is the basis for many disease states, including diabetic foot ulcers.
Studies have shown that ∆-9-tetrahydrocannabinol (∆-9THC) and cannabidiol (CBD) can calm the inflammation down via a few pathways: reducing production of inflammatory mediators (molecules, called cytokines and chemokines, normally released to initiate inflammatory response, but also destructive for surrounding tissue when over-activated) and the induction of regulatory T cells (immune cells that re-group other immune cells in an effort to calm the inflammation down).
CBD has been shown to exert inhibitory effects on several pro-inflammatory cytokines, such as IL-1, IL-12, TNF alfa and interferon-gama (i.e. the “bad guys”) and to enhance IL-4 and IL-10, the anti-inflammatory cytokines (i.e. the “good guys”) (10). In the setting of a diabetic foot ulcer, this would mean reduction of inflammation and repair of the damaged tissue.
Furthermore, Δ9-THC also changes destructive immune cells (TH1) to protective TH2 immune cells, but less effectively than CBD. Both CBD and Δ9-THC can also modulate macrophages, which are scavenger cells in the wound that clean everything up. All the above are pretty compelling pieces of evidence that topical application of cannabis oil would be beneficial for diabetic ulcer treatment.
Another aspect of the refractory nature of diabetic foot ulceration lies in the surrounding tissue of the wound. The main component of this tissue is called extracellular matrix (ECM) which under normal healthy conditions provides support to the surrounding cells, growth factors etc. When inflammation goes awry, the destruction of ECM occurs. The main players here are the “bad guys” I mentioned in the above paragraph. This sets up a vicious cycle in which more inflammatory mediators are recruited resulting in more ECM degradation.
The mechanism behind how cannabis reverses ECM damage could be found in a study on protection of ECM degradation in the cartilage. In this study, cannabinoid agonists have shown to reduce IL-1 which led to decreased degradation of collagen and proteoglycans, the main structural components of ECM, resulting in reduction of ECM breakdown.
Taken together, ample evidence exists in support of using topical cannabis oil for the treatment of diabetic foot ulcers. Although pre-clinical and clinical studies are lacking at this time, the existence of cannabinoid receptors in the skin and on immune cells suggest the potential for beneficial cannabinoid signaling. Moreover, both Δ9-THC and CBD seem to do their part of the job, and thus cannabis oil preparations containing both cannabinoids are likely to confer the most healing benefit to diabetic ulcer lesions.