In the present study, we have evaluated the effects of CBD, a nonpsychoactive component of marijuana, on HG-induced mitochondrial superoxide generation, NF-κB activation, iNOS expression, nitrotyrosine formation, upregulation of adhesion molecules ICAM-1 and VCAM-1, monocyte-endothelial adhesion, TEM of monocytes, and disruption of endothelial barrier function in HCAECs. We demonstrate that CBD attenuates HG-induced mitochondrial superoxide generation, NF-κB activation, nitrotyrosine formation, upregulation of iNOS and adhesion molecules ICAM-1 and VCAM-1, TEM of monocytes, monocyte-endothelial adhesion, and disruption of the endothelial barrier function in HCAECs by a mechanism independent from CB1 and CB2 receptors.
Consistently, CBD has been shown to exert anti-inflammatory and antioxidant effects both in vitro and in various preclinical models of neurodegeneration and inflammatory disorders, independent from classical CB
1 and CB
2 receptors (
6,
8,
14,
19,
20,
22,
25,
31,
37,
46,
53). CBD is devoid of psychoactive effects due to a low affinity for the central nervous system CB
1 receptors (
37,
53) and is well tolerated when chronically administered to humans (
7,
11). CBD has been approved for the treatment of inflammation, pain, and spasticity associated with multiple sclerosis in humans since 2005 (
1,
37). Furthermore, CBD has recently been reported to lower the incidence of diabetes in nonobese diabetic mice (
55) and to preserve the blood-retinal barrier in experimental diabetes (
12).
Numerous epidemiological studies have identified diabetes mellitus as a major risk factor for atherosclerotic cardiovascular diseases such as stroke and coronary heart disease (
26). Hyperglycemia triggers the activation of numerous key mechanisms/pathways, such as reactive oxygen species (
5) and reactive nitrogen species (
40,
41), poly(ADP-ribose) polymerase (
3,
36,
39,
42,
51), protein kinase C (
24), advanced glycation end products (
4), and aldose reductase (
23,
35), eventually leading to endothelial dysfunction in diabetic blood vessels underlying the development of various diabetic complications.
Superoxide production plays a significant role in the pathogenesis of the diabetes-associated endothelial dysfunction (
5,
18,
34,
47). The cellular sources of superoxide anion are multiple and include NADH/NADPH and xanthine oxidases, the mitochondrial respiratory chain, the arachidonic acid cascade (including lipoxygenase and cycloxygenase), and microsomal enzymes (
5,
18,
34,
47). Among these pathways, mitochondrial generation of superoxide appears to play the most crucial role in diabetic complications (
34). Superoxide can also be converted to hydrogen peroxide (H
2O
2) by superoxide dismutase (SOD), and previous studies have suggested that H
2O
2 plays a central role in NF-κB activation in coronary artery endothelial cells (
9,
10). Hyperglycemia-induced superoxide generation might also favor increased expression of iNOSs through the activation of NF-κB, which increases the generation of nitric oxide. Superoxide anion interacts with nitric oxide, forming the potent cytotoxin peroxynitrite, which attacks various biomolecules in the vascular endothelium, vascular smooth muscle, and myocardium, leading to cardiovascular dysfunction via multiple mechanisms (
38,
41). The pathogenetic role of nitrosative stress and peroxynitrite and downstream mechanisms is not limited to the diabetes-induced cardiovascular dysfunction but also contributes to the development and progression of diabetic nephropathy, retinopathy, and neuropathy in both experimental animals and humans (
38,
41).
An increased adhesion of leukocytes (especially monocytes) to the endothelium followed by transmigration into the subendothelial space is a crucial early event in the pathogenesis of atherosclerosis and certain inflammatory disorders [e.g., inflammatory vascular diseases (
16,
17)]. HG concentration increases the surface expression of adhesion molecules ICAM-1 and VCAM-1 in endothelial cells, adhesion of endothelial cells to monocytes, and TEM of monocytes in vitro, phenomena related to increased reactive oxygen species generation and NF-κB activation (
13,
21,
27,
32,
49,
52). Studies have also demonstrated increased leukocyte-endothelial interactions with monocytes from diabetic patients (
16,
29) and in animal models of diabetes (
16,
54). Recently, Li et al. (
30) have reported that macrophages and vascular smooth muscle cells isolated from diabetic mice exhibited proatherogenic properties, such as enhanced adhesion and migration that were largely dependent on NF-κB activation (
30).
Consistent with these previous reports, we found that HG increased mitochondrial superoxide generation, 3-NT formation, NF-κB activation, upregulation of iNOS and adhesion molecules ICAM-1 and VCAM-1, TEM of monocytes, and monocyte-endothelial adhesion in HCAECs (). HG also decreased endothelial barrier function measured by increased permeability and diminished expression of VE-cadherin in HCAECs (). Remarkably, all the above-mentioned effects of HG were attenuated by CBD (). Since reactive oxygen species/peroxynitrite/NF-κB pathway and downstream effectors, such as poly(ADP-ribose) polymerase-1, play important roles in the destruction of insulin-secreting pancreatic β-cells (reviewed in Ref.
38), it is conceivable that the above-mentioned anti-inflammatory effects of CBD could contribute to the recently observed antidiabetic effects in nonobese diabetic mice (
55).
Collectively, our results suggest that the nonpsychoactive cannabinoid CBD have significant therapeutic benefits against diabetic complications and atherosclerosis by attenuating HG-induced mitochondrial superoxide generation, increased NF-κB activation, upregulation of iNOS and adhesion molecules, 3-NT formation, monocyte-endothelial adhesion, TEM of monocytes, and disruption of the endothelial barrier function. This is particularly encouraging in light of the excellent safety and tolerability profile of CBD in humans.