– PERSPECTIVE |
CO-AUTHORS:
Albert Stuart Reece1,2 | Gary Kenneth Hulse1,2
1University of Western Australia, Crawley,
Western Australia, Australia
2School of Health Sciences, Edith Cowan
University, Joondalup, Western Australia,
Australia
Correspondence:
Albert Stuart Reece, University of Western
Australia, 35 Stirling Hwy, Crawley, WA 6009,
Australia.
Email: stuart.reece@uwa.edu.au
ABSTRACT:
Whilst mitochondrial inhibition and micronuclear fragmentation are well established
features of the cannabis literature mitochondrial stress and dysfunction has recently
been shown to be a powerful and direct driver of micronucleus formation and chromosomal
breakage by multiple mechanisms. In turn genotoxic damage can be
expected to be expressed as increased rates of cancer, congenital anomalies and
aging; pathologies which are increasingly observed in modern continent-wide studies.
Whilst cannabinoid genotoxicity has long been essentially overlooked it may in fact
be all around us through the rapid induction of aging of eggs, sperm, zygotes, foetus
and adult organisms with many lines of evidence demonstrating transgenerational
impacts. Indeed this multigenerational dimension of cannabinoid genotoxicity
reframes the discussion of cannabis legalization within the absolute imperative to
protect the genomic and epigenomic integrity of multiple generations to come.
KEYWORDS: cannabis, chromothripsis, micronucleus
MAIN ARTICLE TEXT:
Recent papers in Science provide penetrating and far-reaching insights
into the mechanisms underlying micronuclear rupture a key genotoxic
engine identified in many highly malignant tumours.1,2 Reactive
oxygen species (ROS) generated either by damaged mitochondria or
the hypoxic tumour microenvironment were shown to damage micronuclear
envelopes, which made them more sensitive to membrane
rupture. Damage occurred by both increased susceptibility to membrane
rupture and impaired membrane repair. Micronuclear rupture is
known to be associated with downstream chromosomal shattering,
pan-genome genetic disruption by chromothripsis, widespread epigenetic
dysregulation and cellular ageing. Clinical expressions of genotoxicity
are expected to appear as cancer, birth defects and ageing.
CHMP7 (charge multivesicular body protein 7) oxidation caused
heterodimerization by disulphide crosslinking and aberrant crosslinking
with membrane bound LEMD2 (LEM-domain nuclear envelope
protein 2) inducing membrane deformation and collapse. ROS-CHMP7
directly induced chromosomal shattering. Oxidized CHMP7 bound
covalently to the membrane repair scaffolding protein ESCRT-III
(endosomal sorting complex required for transport–III). ROS triggered
homo-oligomerization of the autophagic receptor p62/sequestome
re-routing the CMPH7-ESCRT-III complex away from membrane
repair into macroautophagy via the autophagosome and microautophagy
via lysozomes.1–3 Expected downstream consequences of
micronuclear rupture including chromosomal fragmentation, chromothripsis
and cGAS-STING (cyclic adenosine-guanosine synthase–
stimulator of interferon signalling) activation were demonstrated.
Cancer-related innate inflammation is known to drive tumour progression
and distant metastasis. These principles were tested both in normal
and also numerous malignant (including head and neck squamous,
cervical, gastric, ovarian and colorectal cancers) cell lines.1,2 Similar
processes including DNA damage and epigenomic derangements have
also been identified in TH1-lymphocytes during fever indicating that
mitochondriopathic-genotoxic mechanisms may in fact be widespread
and fundamental.4
Received: 26 September 2024 Accepted: 26 September 2024
DOI: 10.1111/adb.70003
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Addiction Biology. 2024;29:e70003. wileyonlinelibrary.com/journal/adb
https://doi.org/10.1111/adb.70003
Cannabis has been known to be linked with both micronuclear
development and mitochondrial inhibition for many decades.5,6
All cannabinoids have been implicated in genotoxicity as the moiety
identified as damaging the genetic material is the central olivetol
nucleus on the C-ring itself.7 This finding implicates Δ8-, Δ9-, Δ10-,
Δ11-tetrahydrocannabinol, cannabigerol, cannabidiol and cannabinol
amongst all other cannabinoids.
Historically, the cancer-cannabis link has been controversial. Differing
results in published studies may be attributed to various factors
including multiple exposures (including tobacco), differences in
study design and the rapid rise of cannabis potency. One often quoted
study actually specifically excluded high level cannabis exposure, which
would now appear to have been a major methodological limitation.8 It
is widely documented that there has been a sharp increase in cannabis
concentration from the 1970s to the present day. THC concentrations
of 25%–30% are commonly noted in cannabis herb and flower sold
commercially, and 100% THC concentrations are well known for cannabinoid
based products such as dabs, waxes and ‘shatter’.
In this context, the recent appearance of a series of continentwide
epidemiological, space–time and causal inferential studies in
both Europe and North America is notable for many positive signals
for various cancers including breast, pancreas, liver, AML, thyroid, testis,
lymphoma, head and neck squamous cancer, total childhood cancer
and childhood ALL.9–15 The literature on cannabis and testicular
cancer is almost uniformly positive and has a relative risk of around
2.6-fold,16 this risk factor is now widely acknowledged17–19 and the
effect is quite fast since the median age of exposure may be about
20 years and the median age of testis cancer incidence is only
31 years. Testicular cancer is the adult cancer responsible for the most
years of life lost.17,18,20,21 The inclusion of several childhood cancers
in association with cannabis exposure obviously implicates transgenerational
transmission of malignant mutagenesis.
An intriguing finding in the case report literature is that in many
cases, cancers occur decades earlier and are very aggressive at diagnosis.
22 Mechanisms such as the synergistic mitochondriopathic–
micronuclear axis presently proposed in the recent Science papers1–4
may directly explain this very worrying observation.
Whilst cancer is thought to be a rare outcome amongst cannabis
exposed individuals, ageing effects are not. A dramatic acceleration
of cellular epigenetic age by 30% at just 30 years was recently
reported23 with indications this effect likely rises with age,24 and
the demonstration that cannabis exposed patients had adverse
outcomes across a wide range of physical and mental health outcomes
including myocardial infarction and emergency room presentations.
25 Importantly, the ageing process itself has been shown to
be due to redistribution of the epigenetic machinery in such a manner
as to produce dysregulation (and widespread reduction) of gene
expression and to be inducible by limited genetic damage resulting
from just a handful of DNA breaks.26 Extremely worryingly, agerelated
morphological changes have been described in both oocytes
and sperm.27,28
Epidemiological studies of European and American cannabiscancer
links are supported by epidemiological, space–time and causal
inferential studies of links between cannabis and congenital
anomalies.29–33 Reported congenital anomalies are clustered in the
cardiovascular, neurological, limb, chromosomal, urogenital and gastrointestinal
systems. The fact that all five chromosomal anomalies
studied here are represented in this list, notwithstanding their high
rate of known foetal loss, is strong evidence for chromosomal misegregation
during germ cell meiosis, which is the genetic precursor to
micronucleus development.34,35 The fact that almost identical results
were reported in both the United States and Europe provides strong
external validation to these findings.30
This is consistent with recent press reports of dramatic increases
in babies and calves born without limbs in both France and
Germany36,37 raising the public health spectre of downstream implications
of food chain contamination. Melbourne, Australia, is a multiethnic
city, which heads the global leaderboard for babies born with
the serious limb anomalies amelia and phocomelia.37–40 This pattern
of elevated rates of major birth defects is not seen in the host nations
from which these migrant populations are derived. Cannabis farms are
increasingly common around Melbourne, just as they are in the
French province of Ain, which has similar concerns.37,41–43
Major epigenetic changes have been found in human sperm,44
which have also been identified in exposed rodent offspring.44–46
Indeed, 21 of the 31 congenital anomalies described following prenatal
thalidomide exposure have also been observed epidemiologically
following prenatal cannabis exposure and 12 of 13 cellular pathways
by which thalidomide operates have been similarly identified in the
cannabis mechanistic literature.47 Both human and rodent epigenomic
studies44–46 and epidemiological studies show that adult cannabis
exposure is linked with the incidence of autism48–53 and cerebral processing
difficulties54–57 in children prenatally exposed. Together, this
data is clear and robust evidence for the transgenerational transmission
of major genotoxic outcomes.
Notwithstanding the well-known ambiguities in the epidemiological
literature for cannabis, it is clear from the above brief overview
that there is strong and compelling evidence that cannabis genotoxic
outcomes are well substantiated and form a remarkably congruent
skein of interrelated evidence across all three domains of genotoxic
pathology including cancer, congenital anomalies and ageing.
So too compelling epidemiological, morphological and epigenetic
evidence of transgenerational transmission of cannabinoid genotoxicity
to foetus, egg, sperm and offspring carries far reaching and
transformative implications and indeed reframes the discussion surrounding
cannabis legalization from merely personal-hedonistic to the
protection of the national genomic integrity for multiple subsequent
generations.
The present time therefore represents a watershed moment.
The new profoundly insightful studies from Science point the way and
provide the trigger. Clearly, there is a great need for a new
and updated cohort of epidemiological studies on these issues at the
population level in the modern context of the widespread availability
of much more potent cannabinoid preparations.
However, our first responsibility is to act on the evidence we do
have. Given the uniform picture painted by data from myriad directions.
It can be said that the evidence for cannabinoid genotoxicity
is at once so clinically significant, robust and compelling as to constitute
a resounding clarion call to action: The only outstanding
question is ‘Will we rise to the challenge?’
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CONFLICT OF INTEREST STATEMENT:
The authors declare no conflicts of interest.
ORCID:
Albert Stuart Reece https://orcid.org/0000-0002-3256-720X
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How to cite this article: Reece AS, Hulse GK. Key insights into
cannabis-cancer pathobiology and genotoxicity. Addiction
Biology. 2024;29(11):e70003. doi:10.1111/adb.70003
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