Results from different studies showing CB2 receptor-associated cardioprotective action are still fairly controversial and no single specific mechanism could be identified. Several groups investigated the involvement of the endocannabinoid system in cellular systems and function of cardiomyocytes, fibroblasts, macrophages and endothelial cells. While some studies are limited in their translational relevance, a few recent studies describe a myocardial ischemia and reperfusion scenario in a fashion comparable to the clinical situation. Recent studies provided evidence for involvement of the CB2 receptor–endocannabinoid axis in prevention of cardiomyocyte apoptosis including modulation of antioxidative enzymes and contractile elements expression. CB2 receptor has further been shown to specifically modulate the inflammatory response and macrophage function after myocardial ischemia. These effects have an impact on the subsequent myocardial remodeling, where the CB2 receptor modulates function of myofibroblasts, collagen production and limitation of myocardial infarction size. Recent experimental and clinical data showed the association of the endocannabinoid system in myocardial hypertrophy. In conclusion, increasing amount of evidence supports a crucial role of the endocannabinoid system in cardioprotection and myocardial remodeling, while some of them even suggest model-independent systemic effects in adaptation of cardiomyocytes or components of the extracellular matrix.
Part of the book: Cannabinoids in Health and Disease