What Israel can tell us about the use of cannabinoids in COVID-19 treatment

Carl Esprey, CEO of Botanical Holdings, summarises the numerous studies being conducted in Israel in the use of medicinal cannabis for COVID-19.

We are now one year into the COVID-19 pandemic and in the early stages of the best method of treatment for the virus with biggest vaccination campaign in history. According to the Bloomberg tracker, more than 345 million doses of the vaccine have been administered across 1,232 countries so far, at the rate of about 8.74 million doses a day.

But it is understood that success of the vaccine will not eliminate risk of the virus. After all, no population can be completely inoculated. Disease modelers in the UK have projected more than 56,000 COVID-19 deaths in the country by summer next year, even with effective vaccination. This creates a greater necessity for supportive treatment options since the pandemic will continue to take a toll on society.

In therapeutic management of the disease, Remdesivir (an antiviral) and Dexamethasone (a corticosteroid) have been at the forefront of mainstream treatment. The latter can be useful especially in cases where patients have developed a hyper-immune response to the viral infection. Known as a cytokine storm, this condition can lead to acute respiratory distress syndrome (ARDS), organ damage, and even respiratory failure.

It can be difficult to develop treatments for a viral pandemic. However, a number of clinical studies in alternate treatment paths – such as monoclonal antibodies and convalescent plasma – have been underway. Researchers are also testing medications ordinarily used to treat other conditions, to check for their effect against COVID-19.

Some researchers are exploring the potential benefit of cannabinoids against lung inflammation in COVID-19. We know that non-psychotropic cannabidiol (CBD) is an anti-inflammatory agent, and it is used in the management of various chronic diseases, such as epileptic seizures in children. What if medicinal cannabis could have similar benefits in the treatment for COVID-19?

Israel explores the use of cannabinoids for COVID-19 treatment

Israel has been leading the way in medicinal cannabis research for years. The country launched a number of studies last year to investigate the benefits of cannabis-derived treatments for COVID-19. Some of these have shown significant therapeutic potential of CBD in the treatment for COVID-19.

One of these projects, spearheaded by InnoCanPharma and Tel Aviv University, involves the inhalation of CBD-loaded exosomes for the treatment of lung infections. Exosomes are extracellular vesicles responsible for inter-cell communication. Cannabinoids seemed to have a positive impact on several inflammatory markers that occur in COVID patients.

Other studies are testing the efficacy of CBD-steroid combinations against COVID-19. Steroid applications are already being used as the immediate line of treatment for many hospitalized patients. In a study by Rabin Medical Center at Beilinson Hospital, CBD was found to enhance the therapeutic effect of these steroidal treatments.

The pilot trial started early this year with the Helsinki Committee’s approval. Of the 11 critical COVID-19 patients treated in the first study, 8 experienced improvements in the respiratory infections they were suffering from. These improvements were sufficient to warrant the patients’ release from the hospital within 1 to 4 weeks. The small size of the study means the results are not conclusive, but they merit testing on a larger scale.

Early results from another exploratory study, being conducted by the Israeli R&D companies Eybna and CannaSoul Analytics, lend further support to the case of medicinal cannabis as a potential treatment for COVID-19. The study explores the benefits of a proprietary formulation called NT-VRL™, developed by Eybna out of 30 individual terpenes, for the treatment of inflammatory conditions in COVID-19.

Among these conditions, cytokine storms or acute respiratory distress syndrome (ARDS) is one of the deadliest symptoms. It can cause hyperactivity of the patient’s immune system to the extent that organs are inundated with cytokine peptides. In severe cases, this can lead to loss of organ function and even death.

Terpenes are aromatic organic compounds, found in high concentrations in cannabis plants. This particular study was created to test their anti-inflammatory properties in regulating these cytokine storms.

The researchers also conducted tests with CBD, CBD- NT-VRL™ combination, and dexamethasone. CBD inhibited around 75% of the cytokine activity on average, while NT-VRL™ alone had about 80% inhibition impact, with higher doses yielding better results. But the combination of CBD and NT-VRL™ outperformed the other agents with a 90% inhibition effect. This is two times more effective than the recommended corticosteroid treatment.

What we can learn from these key findings

These studies show that medicinal cannabis could indeed be effective in the treatment of COVID-19, particularly for inflammatory symptoms like ARDS. CBD seems to work in a similar way as tetrahydrocannabinol (THC), a type of cannabinoid that can help decrease lung inflammation by suppressing hyperimmune responses.

CBD formulations were shown to modulate the body’s autoimmune responses and help improve respiratory functions. In fact, earlier studies have mimicked ARDS-induced lung damage in mice to show that CBD can improve clinical symptoms of hyper-inflammation caused by COVID-19. Further examination showed that CBD was shown to reverse tissue overgrowth, scarring, and swelling in the damaged lungs.

These are encouraging results, but they need to be reviewed and validated by the scientific community before they can be ready for clinical application. It is important to understand that cannabinoids are not a failsafe anti-inflammatory treatment. Their effect on the patient will depend on the stage of the disease.

In the early stages, the patient’s immune system must be strong enough to mount a response against the infection. But in the later stages, a hyperactive immune system can cause cytokine storms. It is then that the immunosuppressive function of cannabinoids can offer relief to the affected bio-mechanism.

Evaluation of the efficacy of cannabinoids at various stages of COVID-19 infection is therefore key to developing a safe treatment protocol for the disease.