Hypoxic-ischemic encephalopathy (HIE) is the technical, medical term for a type of brain damage resulting from an interruption in the flow of oxygenated blood to the brain. Newborns are particularly affected by this condition when they have experienced oxygen deprivation (or birth asphyxia) close to or at the time of birth.
Therapeutic hypothermia is currently the most common and effective treatment for HIE. This treatment cools down the brain in a controlled environment, causing the metabolism of the baby to slow down sufficiently to give time for the brain cells to re-form. As a result, brain damage is minimized, resulting in better outcomes for the long-term.
Although this treatment is often effective, it is not considered a cure. Babies suffering from HIE who receive therapeutic hypothermia often still retain long-term or permanent disabilities, such as cerebral palsy.
However, a potential new treatment for HIE in babies involves the use of cannabidiol (CBD).
What is cannabidiol (CBD)?
Cannabidiol is a compound derived from the cannabis plant. Unlike tetrahydrocannabinol (THC), however, CBD does not contain the percentage of THC that gives users a “high.” CBD has become a popular treatment for various conditions due to its medicinal properties and lack of psychoactive effects. A number of studies have investigated the use of CBD as a neuroprotective agent and its ability to mitigate the effects of certain conditions, such as Alzheimer’s, multiple sclerosis, epilepsy, and Parkinson’s disease.
CBD to treat HIE in newborns
Current research on CBD has demonstrated its ability to minimize damage from oxidative stress, less neuro-inflammation, and diminished glutamate related excitotoxicity, all three of which are considered factors that contribute to brain damage.
CBD used in treating neonatal HIE has recently been authorized for clinical trial in other countries. Preclinical trial work by Lorena Barata and colleagues, head of the Neonatology Division at San Carlos Hospital in Madrid, has shown neuroprotective effects of CBD. The subjects they used for their study were one-day-old piglets with HIE injuries. Some of the piglets were given normothermia, others were given therapeutic hypothermia, and others were given CBD. Still others were given a placebo.
CBD combined with hypothermia
The results of the study found that CBD provided a measure of neuroprotection, particularly when applied along with therapeutic hypothermia. Both treatments working together produced more effective results than each treatment acting alone. In fact, according to Dr. José Antonio Martínez-Orgado, one of the authors of the study, the brain damage in the piglets was reduced by virtually 100 percent.
This success has led to a clinical trial on CBD in human newborns with brain injuries at birth, supported by GW Pharmaceuticals. The trial, to be conducted in the United Kingdom and Spain, will use the same method of intravenous administration that was used on the piglets. One group of babies will be given therapeutic hypothermia exclusively. Another group will be given therapeutic hypothermia with CBD. A third group will be given a placebo with therapeutic hypothermia.
The CBD administered to the infants will be purified carefully to eliminate any potential harmful effects of other cannabinoids when administered intravenously.
There will be some challenges with this study on infants compared to the more predictable preclinical setting involving piglets. With the human babies, the time of the injury is not as certain as it was with the piglets, who were given HIE injuries for the purpose of the study.
In addition, the effective window for treatment with CBD, based on a previous study on mice, may be wider than the narrower effective window of treatment of about six hours with therapeutic hypothermia alone.
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