Rôle et implication du système cannabinoïde dans la modulation périphérique de la douleur inflammatoire et neuropathique

Opium (opioids) and cannabis (cannabinoids) derivatives present many interesting properties. Following the identification of their respective receptors, various pharmacological strategies have tried to exploit their analgesic properties. The cloning of cannabinoid CB1 and CB2 receptors has promoted the discovery of endogenous agonists of these receptors named endocannabinoids. The two mostly studied endocannabinoids are anandamide and 2-arachidonoyl glycerol (2-AG). This has also led to the identification of enzymes that catalyze the inactivation of these endogenous cannabinoids: a fatty acid amide hydrolase or FAAH and a monoacylglycerol lipase or MAGL. It is known that the endogenous cannabinoid system is upregulated in a variety of pathological processes, such as inflammatory and neuropathic pain. This increase is usually interpreted as a physiological response to restore homeostasis and it was particularly observed in the periphery. Endocannabinoids seem to act specifically at key moments in targeted tissues to minimize the consequences related to the onset of pain. This observation is very interesting from a therapeutic perspective because it suggests the possibility of targeting the endocannabinoid degrading enzymes in order to increase their local concentrations and thus prolong their neuromodulatory action. At the peripheral level, the activation of cannabinoid receptors induces beneficial antinociceptive effects while minimizing side effects often associated with their central activation. We focused our work on the peripheral modulation of this endogenous system using inhibitors of endocannabinoid degrading enzymes to assess their therapeutic potential and to elucidate the mechanisms of action underlying their effects in animal models of inflammatory and neuropathic pain. We have demonstrated that this approach can relieve the symptoms associated with these two types of pain, through the activation of CB1 and CB2 receptors. The opioid and cannabinoid systems have similarities, including comparable locations along the pain pathways, mechanisms of action relayed by G protein-coupled receptors and common pharmacological properties such as analgesia. The opioid system is involved in the antinociceptive effects induced by cannabinoids. In contrast, the participation of the cannabinoid system in those induced by morphine remains uncertain. We have demonstrated that peripheral and spinal antinociceptive effects induced by morphine are reduced in genetically modified mice in which the expression of CB1 and CB2 receptors was eliminated, suggesting a role for these receptors in the effects of morphine. We have further demonstrated that the decrease in morphine-induced analgesia in these mice is not caused by a malfunction of the mu opioid receptors (MOP) or by a down-regulation of these receptors. Our results confirm the existence of functional interactions between cannabinoid and opioid systems at the peripheral and spinal levels. These findings are promising from a therapeutic perspective since a targeted modulation of the levels of endocannabinoids and endogenous opioids would induce potentially synergistic beneficial analgesic effects while minimizing side effects associated with the central activation of these systems.

Keyphrases: anandamide, morphine, 2-arachidonoylglycerol, anandamide, cannabinoid receptors, monoacylglycerol lipase, fatty acid amide hydrolase, mu opioid receptors, inflammatory pain, neuropathic pain