1
|
Cho S, Chu MK. Serological Biomarkers of Chronic Migraine. Curr Pain Headache Rep 2023; 27:531-542. [PMID: 37561314 DOI: 10.1007/s11916-023-01154-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE OF REVIEW Chronic migraine (CM) is a chronic form of migraine that differs from episodic migraine (EM) in terms of prevalence, comorbidities, response to treatment, and biomarkers. The aim of this review was to summarize the recent findings on serological biomarkers of CM. RECENT FINDINGS Neuronal, inflammatory, and vascular markers have been investigated to assess their diagnostic and prognostic ability and treatment effectiveness. Several markers showed significant alterations according to disease status and treatment response in CM. Calcitonin gene-related peptide (CGRP), glutamate, and adiponectin appear to be the most promising blood biomarkers for CM. Most studies have shown altered ictal and interictal levels of these markers in CM compared with those in EM and controls. Additionally, they showed a significant association with treatment outcomes. Total adiponectin and high-molecular-weight adiponectin levels were less studied as biomarkers of CM than CGRP and glutamate levels but showed promising results. The development of suitable biomarkers could revolutionize the diagnosis and treatment of CM and ultimately decrease the disability and societal costs of the disease.
Collapse
Affiliation(s)
- Soomi Cho
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Min Kyung Chu
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|
2
|
Andreou AP, Pereira AD. Migraine headache pathophysiology. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:61-69. [PMID: 38043971 DOI: 10.1016/b978-0-12-823356-6.00018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
In both episodic and chronic migraine, headache is the most disabling symptom that requires medical care. The migraine headache is the most well-studied symptom of migraine pathophysiology. The trigeminal system and the central processing of sensory information transmitted by the trigeminal system are of considerable importance in the pathophysiology of migraine headache. Glutamate is the main neurotransmitter that drives activation of the ascending trigeminal and trigeminothalamic pathways. The neuropeptide, calcitonin gene-related peptide (CGRP) that is released by the trigeminal system, plays a crucial role in the neurobiology of headache. Peripheral and central sensitizations associated with trigeminal sensory processing are neurobiologic states that contribute to both the development of headache during a migraine attack and the maintenance of chronic migraine.
Collapse
Affiliation(s)
- Anna P Andreou
- Headache Research-Wolfson Centre for Age-Related Diseases (CARD), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Headache Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Ana D Pereira
- Headache Research-Wolfson Centre for Age-Related Diseases (CARD), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| |
Collapse
|
3
|
Uygur-Kucukseymen E, Akca G. Serum lipid profile in migraine and its association with clinical characteristics. Neurol Res 2023; 45:57-61. [PMID: 36062535 DOI: 10.1080/01616412.2022.2119723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Migraine is one of the most prevalent and disabling conditions worldwide. Dyslipidemia has become an issue of great importance recently in migraine patients. There is still no consensus on the relationship between specific lipid levels with clinical characteristics of migraine and patients' demographic features. In this study, we investigated each serum lipid level in migraine patients and correlated it with migraine and patients' characteristics to understand the contribution of these factors together. METHODS In this case-control study, 100 patients with migraine and 76 healthy control subjects were included. Serum lipid levels were calculated and compared with the control group. Also, we analyzed the clinical characteristics of patients and their correlation with lipid levels. Regression analyses were performed to identify the predictors of serum lipid levels. RESULTS Total cholesterol (TC), triglyceride (TG), and surprisingly high-density lipoprotein (HDL-c) levels were found significantly higher in the migraine group. Also, low-density lipoprotein (LDL-c) level showed a trend of increase and has become significantly higher in the migraine group after adjusting by age. Moreover, there was a positive correlation only between age and TC, LDL-c, and TG levels among the clinical characteristics of migraine and patients' demographic features. DISCUSSIONS Due to accompanying dyslipidemia, migraine might be considered a risk factor for vascular events regardless of its clinical characteristics. Notwithstanding, elevated HDL-c levels may play a protective role for the vascular events. This dilemma needs to be further explored in future trials to reveal potential biological mechanisms of lipids in migraine patients and to find the optimal therapeutic approach to dyslipidemia.
Collapse
Affiliation(s)
| | - Gizem Akca
- Department of Neurology, Neurology Clinic of Kepez State Hospital, Antalya, Turkey
| |
Collapse
|
4
|
Abstract
Background Disability from migraine has a profound impact on the world's economy. Research has been ongoing to identify biomarkers to aid in diagnosis and treatment. Objective The aim of this study was to highlight the purported diagnostic and therapeutic migraine biomarkers and their role in precision medicine. Methods A comprehensive literature search was conducted using PubMed, Google Scholar, and clinicaltrials.gov using keywords: "migraine" OR "headache" combined with "biomarkers" OR "marker." Other keywords included "serum," "cerebral spinal fluid," "inflammatory," and "neuroimaging." Results After a review of 88 papers, we find the literature supports numerous biomarkers in the diagnosis of migraine. Therapeutic biomarkers, while not as extensively published, highlight calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating peptide-38 (PACAP-38) as biomarkers with the most substantiated clinical relevance. Genetic markers mainly focusing on gene mutations with resultant biochemical alterations continue to be studied and show promise. Conclusion Although there are several proposed biomarkers for migraine, continued research is needed to substantiate their role in clinical practice.
Collapse
Affiliation(s)
- Brian M Yan
- Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | | | - Ayesha Ahmad
- Department of Neurology, Thomas Jefferson University, USA
| | | |
Collapse
|
5
|
Paolucci M, Altamura C, Vernieri F. The Role of Endothelial Dysfunction in the Pathophysiology and Cerebrovascular Effects of Migraine: A Narrative Review. J Clin Neurol 2021; 17:164-175. [PMID: 33835736 PMCID: PMC8053543 DOI: 10.3988/jcn.2021.17.2.164] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/17/2022] Open
Abstract
Background and Purpose Migraine is a complex neurovascular disorder whose triggers are not entirely understood. Endothelial dysfunction might play a role in migraine, and there have been numerous reports on endothelium dysfunction and migraine pathophysiology, but their reciprocal cause–effect relationship remains unclear. This review reports the current evidence on endothelium dysfunction, its link with migraine, and its possible consequences for cerebral hemodynamics. Methods We performed a systematic literature search of PubMed up to March 2020. We included 115 articles in a narrative review. Results Several studies have demonstrated that endothelium dysfunction may play an important role in migraine. Despite the lack of specific biomarkers, there is evidence of oxidative stress and inflammation—two of the primary causes of endothelial damage—in migraine. The main consequences of endothelial dysfunction are increased vascular tone, thrombosis, inflammation, and increased vascular permeability. As a consequence of oxidative stress, the activity of endothelin-1 is not counterbalanced by nitric oxide (NO), whose levels decrease to lead to vasoconstriction and a possible contribution to cortical spreading depression. NO is involved in pain perception via the cyclic guanosine monophosphate (cGMP) pathway and the induction of calcitonin gene-related peptide. Oxidative stress may induce a hypercoagulable state that mainly affects platelet function through different mechanisms. Endothelial dysfunction seems to be particularly pronounced in migraine with aura (MA). Endothelial dysfunction in migraine particularly involves intracranial vessels, since flow-mediated dilation cannot detect overt peripheral vascular dysfunction. Conclusions Endothelial dysfunction is a vascular risk marker. How it impacts migraine, and particularly MA, needs to be understood better by defining its possible role in increasing the stroke risk in migraine patients.
Collapse
Affiliation(s)
- Matteo Paolucci
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University of Rome, Rome, Italy.,Neurology Unit, M. Bufalini Hospital, Cesena, AUSL Romagna, Italy.
| | - Claudia Altamura
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University of Rome, Rome, Italy
| |
Collapse
|
6
|
Liampas I, Mylonas KS, Brotis A, Dervenis P, Siokas V, Mentis AFA, Dastamani M, Aloizou AM, Tsouris Z, Aslanidou P, Bakoyiannis C, Dardiotis E. Serum lipid abnormalities in migraine: A meta-analysis of observational studies. Headache 2021; 61:44-59. [PMID: 33398889 DOI: 10.1111/head.14039] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/15/2020] [Accepted: 09/26/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The association of migraine with vascular comorbidities is long-established. The contribution of the "traditional" cardiovascular risk factors to this connection remains unclear. OBJECTIVE To determine-quantify the differences in the serum lipid concentrations between lipid-lowering agents-naïve individuals with migraine and healthy controls (HC). METHODS The study protocol was not preregistered with an online systematic review-protocol registry. A literature search involving MEDLINE, EMBASE, CENTRAL, Google Scholar, and the OpenGrey database was performed. Case-control, cross-sectional, or cohort studies involving HC and participants with migraine (with and without aura regardless of the use of prophylactic treatment) that quantitatively assessed serum low-density lipoprotein cholesterol (LDL-C) (primary index) and/or total cholesterol (TC) and/or high-density lipoprotein cholesterol (HDL-C) and/or triglycerides (TG) (secondary indices) were retrieved. Articles including participants with known dyslipidemia (or under lipid-lowering medications) or with secondary causes of dyslipidemia (aside from the subjectively assessed lifestyle parameters) were excluded. Studies with abstracts and full texts not published in English and articles reporting the implementation of other study designs (reviews, meta-analyses, commentaries, case reports, etc.) were excluded as well. Conference abstracts and English abstracts from studies with full texts not published in English were evaluated as part of the gray literature. Each step of the review process was performed by two investigators independently, and relevant data were abstracted based on standardized extraction forms. Any discrepancies were resolved by a third investigator. RESULTS Seventeen studies (16 case-control and 1 cross-sectional) fulfilled the eligibility criteria. Retrieved articles involved adult participants, principally during the fourth decade of life. Results were compatible with higher LDL-C levels in migraine individuals (1370) than in HC (1215) [12 studies, mean difference (MD) = 10.4 mg/dl, 95% confidence interval (CI) = (1.6, 19.2)]. Similarly, higher TC levels were determined in migraine patients [14 studies, migraine = 1325, HC = 1213, MD = 10.6 mg/dl, 95% CI = (1.8, 19.3)], as were TG levels [15 studies, migraine = 1526, HC = 1262, MD = 11.8 mg/dl, 95% CI = (3.6, 20.0)]. HDL-C concentrations were not different between the two groups [14 studies, migraine = 1488, HC = 1328, MD = -0.4 mg/dl, 95% CI = (-2.2, 1.5)]. Prespecified sensitivity analysis following the exclusion of studies not presenting comparable body mass index values between the groups nullified the significant difference regarding LDL-C levels [MD = 5.3 mg/dl, 95% CI = (-0.1, 10.8)]. Subgroup analyses as well as the direct comparison of migraine with aura and migraine without aura individuals were compatible with no difference regarding lipid concentrations, but only a small fraction of the retrieved studies presented relevant figures. CONCLUSIONS Although our results are of limited generalizability, since most retrieved studies were performed in Turkey (nine studies), TC abnormalities may provide part of the explanation for the unfavorable cardiovascular profile of migraine patients. Lifestyle may be partly or entirely accountable for the determined increased serum TC. Additional studies that will completely address the effect that lifestyle parameters exert on lipid concentrations are required to better capture existing abnormalities.
Collapse
Affiliation(s)
- Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Konstantinos S Mylonas
- Department of Cardiac Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
| | - Alexandros Brotis
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | | | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Alexios-Fotios A Mentis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece.,Public Health Laboratories, Hellenic Pasteur Institute, Athens, Greece
| | - Metaxia Dastamani
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Athina-Maria Aloizou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Zisis Tsouris
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Paraskevi Aslanidou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | - Christos Bakoyiannis
- Division of Vascular Surgery, First Department of Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| |
Collapse
|
7
|
Ran C, Michalska JM, Fourier C, Sjöstrand C, Waldenlind E, Steinberg A, Belin AC. Analysis of NOS Gene Polymorphisms in Relation to Cluster Headache and Predisposing Factors in Sweden. Brain Sci 2020; 11:brainsci11010034. [PMID: 33396232 PMCID: PMC7824326 DOI: 10.3390/brainsci11010034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/28/2022] Open
Abstract
Cluster headache is characterized by activation of the autonomic-trigeminal reflex. Nitric oxide can trigger headaches in patients, and nitric oxide signaling is known to be affected in cluster headache. Based on the hypothesis of nitric oxide being involved in cluster headache pathophysiology we investigated nitric oxide synthases as potential candidate genes for cluster headache. We analyzed eight variants in the three forms of nitric oxide synthase (NOS) genes, inducible NOS (iNOS), endothelial NOS (eNOS) and neuronal NOS (nNOS), and tested for association with cluster headache. Swedish cluster headache patients (n = 542) and controls (n = 581) were genotyped using TaqMan® assays on an Applied Biosystems 7500 qPCR cycler. This is the largest performed genetic study on NOS involvement in cluster headache so far. We found an association between cluster headache and one iNOS haplotype consisting of the minor alleles of rs2297518 and rs2779249 (p = 0.022). In addition, one of the analyzed nNOS variants, rs2682826, was associated with reported triptan use (p = 0.039). Our data suggest that genetic variants in NOS genes do not have a strong influence on cluster headache pathophysiology, but that certain combinations of genetic variants in NOS genes may influence the risk of developing the disorder or triptan use.
Collapse
Affiliation(s)
- Caroline Ran
- Department of Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (J.M.M.); (C.F.); (A.C.B.)
- Correspondence: ; Tel.: +46-(0)8-5248-7051
| | - Julia M. Michalska
- Department of Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (J.M.M.); (C.F.); (A.C.B.)
| | - Carmen Fourier
- Department of Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (J.M.M.); (C.F.); (A.C.B.)
| | - Christina Sjöstrand
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.S.); (E.W.); (A.S.)
| | - Elisabet Waldenlind
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.S.); (E.W.); (A.S.)
- Department of Neurology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Anna Steinberg
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (C.S.); (E.W.); (A.S.)
- Department of Neurology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Andrea C. Belin
- Department of Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden; (J.M.M.); (C.F.); (A.C.B.)
| |
Collapse
|
8
|
Yilmaz S. Serum NO, S100B, NSE concentrations in migraine and their relationship. J Clin Neurosci 2020; 82:32-35. [PMID: 33317735 DOI: 10.1016/j.jocn.2020.10.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/30/2020] [Accepted: 10/18/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Migraine pathogenesis still remains uncertain. Studies have found contradictory results regarding NO, S100B and NSE parameters in migraine patients. Therefore, in our study, we aimed to measure NO, S100B and NSE concentrations in migraine patients, compare them with the control group and find the relationship between these parameters. MATERIALS AND METHODS Fifty-two patients (35 women and 17 men) diagnosed with migraine according to the International Headache Classification II criteria were included in the study. 30 healthy participants without any history of disease were included in the control group. Serum NO, S100B and NSE levels were determined in all participants. RESULTS It was found that NO, S100B parameters increased compared to the control group, and NSE parameter decreased compared to the control group in the migraine patients participating in this study (p = 0,004, p = 0,002, p = 0,000) It was found that there was a moderate positive linear correlation between serum S100B and NSE in the migraine patients in our study (r = 442, p = 0.011). CONCLUSION In our study, the fact that there was a statistically significant difference in the NO, S100b and NSE parameters of migraine and control group patients indicates that these molecules can be effective in the pathogenesisof migraine. The moderate positive linear correlation found between serum S100B and NSE in migraine patients in our study demonstrates that these molecules together can be effective in the pathogenesis.
Collapse
Affiliation(s)
- Sedat Yilmaz
- Department of Medical Biochemistry, Medicine Faculty of Adiyaman University, Adiyaman, Turkey.
| |
Collapse
|
9
|
Pentraxin 3 (PTX3): A Molecular Marker of Endothelial Dysfunction in Chronic Migraine. J Clin Med 2020; 9:jcm9030849. [PMID: 32244987 PMCID: PMC7141491 DOI: 10.3390/jcm9030849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 01/03/2023] Open
Abstract
Even though endothelial dysfunction is known to play a role in migraine pathophysiology, studies regarding levels of endothelial biomarkers in migraine have controversial results. Our aim was to evaluate the role of pentraxin 3 (PTX3) and soluble tumour necrosis factor-like weak inducer of apoptosis (sTWEAK) as potential biomarkers of endothelial dysfunction in chronic migraine (CM). We performed a case-control study including 102 CM patients and 28 control subjects and measured serum levels of markers of endothelial dysfunction (PTX3 and sTWEAK) and inflammation [high-sensitivity C-reactive protein (hs-CRP)] as well as brachial artery flow-mediated dilation (FMD) during interictal periods. Interictal serum levels of PTX3 and sTWEAK were higher in CM patients than in controls (1350.6 ± 54.8 versus 476.1 ± 49.4 pg/mL, p < 0.001 and 255.7 ± 21.1 versus 26.4 ± 2.6 pg/mL, p < 0.0001; respectively). FMD was diminished in CM patients compared to controls (9.6 ± 0.6 versus 15.2 ± 0.9%, p < 0.001). Both PTX3 and sTWEAK were negatively correlated with FMD (r = −0.508, p < 0.001 and r = −0.188, p = 0.033; respectively). After adjustment of confounders, PTX3 remained significantly correlated to FMD (r = −0.250, p = 0.013). Diagnosis of CM was 68.4 times more likely in an individual with levels of PTX3 ≥ 832.5 pg/mL, suggesting that PTX3 could be a novel biomarker of endothelial dysfunction in CM.
Collapse
|
10
|
Ferroni P, Barbanti P, Spila A, Fratangeli F, Aurilia C, Fofi L, Egeo G, Guadagni F. Circulating Biomarkers in Migraine: New Opportunities for Precision Medicine. Curr Med Chem 2019; 26:6191-6206. [DOI: 10.2174/0929867325666180622122938] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/24/2018] [Accepted: 05/30/2018] [Indexed: 01/03/2023]
Abstract
Background:
Migraine is the most common neurological disorder and the second
most disabling human condition, whose pathogenesis is favored by a combination of genetic,
epigenetic, and environmental factors. In recent years, several efforts have been made to identify
reliable biomarker(s) useful to monitor disease activity and/or ascertain the response to a
specific treatment.
Objective:
To review the current evidence on the potential biological markers associated with
migraine.
Methods:
A structured search of peer-reviewed research literature was performed by searching
major publications databases up to December 2017.
Results:
Several circulating biomarkers have been proposed as diagnostic or therapeutic tools
in migraine, mostly related to migraine’s inflammatory pathophysiological aspects. Nonetheless,
their detection is still a challenge for the scientific community, reflecting, at least in part,
disease complexity and clinical diagnostic limitations. At the present time, calcitonin generelated
peptide (CGRP) represents probably the most promising candidate as a diagnostic
and/or therapeutic biomarker, as its plasma levels are elevated during migraine attack and decrease
during successful treatment. Other molecules (including some neuropeptides, cytokines,
adipokines, or vascular activation markers) despite promising, do not possess the sufficient
prerequisites to be considered as migraine biomarkers.
Conclusion:
The characterization of migraine-specific biomarkers would be fundamental in a
perspective of precision medicine, enabling risk assessment and tailored treatments. However,
speculating on the clinical validity of migraine biomarkers may be premature and controlled
clinical trials are presently needed to investigate both the diagnostic and therapeutic value of
these biomarkers in migraine.
Collapse
Affiliation(s)
- Patrizia Ferroni
- InterInstitutional Multisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, 00166, Rome, Italy
| | - Piero Barbanti
- Headache and Pain Unit, Dept. of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, 00166, Rome, Italy
| | - Antonella Spila
- InterInstitutional Multisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, 00166, Rome, Italy
| | - Federica Fratangeli
- InterInstitutional Multisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, 00166, Rome, Italy
| | - Cinzia Aurilia
- Headache and Pain Unit, Dept. of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, 00166, Rome, Italy
| | - Luisa Fofi
- Headache and Pain Unit, Dept. of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, 00166, Rome, Italy
| | - Gabriella Egeo
- Headache and Pain Unit, Dept. of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, 00166, Rome, Italy
| | - Fiorella Guadagni
- InterInstitutional Multisciplinary Biobank (BioBIM), IRCCS San Raffaele Pisana, 00166, Rome, Italy
| |
Collapse
|
11
|
Farajzadeh A, Bathaie SZ, Arabkheradmand J, Ghodsi SM, Faghihzadeh S. Different Pain States of Trigeminal Neuralgia Make Significant Changes in the Plasma Proteome and Some Biochemical Parameters: a Preliminary Cohort Study. J Mol Neurosci 2018; 66:524-534. [DOI: 10.1007/s12031-018-1183-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 09/24/2018] [Indexed: 01/03/2023]
|
12
|
High asymmetric dimethylarginine, symmetric dimethylarginine and L-arginine levels in migraine patients. Neurol Sci 2017; 38:1287-1291. [PMID: 28455769 DOI: 10.1007/s10072-017-2970-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
Experimental and clinical data strongly suggests that nitric oxide (NO) plays a pivotal role in migraine. This is also supported by studies of migraine induced by substances that release NO. NO is synthesized from L-arginine by endothelial NO synthase (NOS). Asymmetric dimethylarginine (ADMA) is the major endogenous competitive inhibitor of NOS. Symmetric dimethylarginine (SDMA) is an inactive stereoisomer of ADMA. It may reduce NO production by competing with arginine for cellular uptake. The aim of this study was to measure the levels of ADMA, SDMA and L-arginine in migraine patients during the interictal period. One hundred migraine patients and 100 healthy volunteers were recruited. The patients were in the interictal period and classified into two groups as having migraine with aura and migraine without aura. Their serum ADMA, SDMA and L-arginine levels were measured by high-performance liquid chromotography (HPLC) method. ADMA, SDMA and L-arginine levels were significantly higher in migraine patients compared to the control group. But there was no difference between the patients with and without aura. These results suggest that NOS inhibitors and L-arginine/NO pathway plays an important role in migraine pathopysiology.
Collapse
|
13
|
Abstract
Neurogenic inflammation, a well-defined pathophysiologial process is characterized by the release of potent vasoactive neuropeptides, predominantly calcitonin gene-related peptide (CGRP), substance P (SP), and neurokinin A from activated peripheral nociceptive sensory nerve terminals (usually C and A delta-fibers). These peptides lead to a cascade of inflammatory tissue responses including arteriolar vasodilation, plasma protein extravasation, and degranulation of mast cells in their peripheral target tissue. Neurogenic inflammatory processes have long been implicated as a possible mechanism involved in the pathophysiology of various human diseases of the nervous system, respiratory system, gastrointestinal tract, urogenital tract, and skin. The recent development of several innovative experimental migraine models has provided evidence suggestive of the involvement of neuropeptides (SP, neurokinin A, and CGRP) in migraine headache. Antidromic stimulation of nociceptive fibers of the trigeminal nerve resulted in a neurogenic inflammatory response with marked increase in plasma protein extravasation from dural blood vessels by the release of various sensory neuropeptides. Several clinically effective abortive antimigraine medications, such as ergots and triptans, have been shown to attenuate the release of neuropeptide and neurogenic plasma protein extravasation. These findings provide support for the validity of using animal models to investigate mechanisms of neurogenic inflammation in migraine. These also further strengthen the notion of migraine being a neuroinflammatory disease. In the clinical context, there is a paucity of knowledge and awareness among physicians regarding the role of neurogenic inflammation in migraine. Improved understanding of the molecular biology, pharmacology, and pathophysiology of neurogenic inflammation may provide the practitioner the context-specific feedback to identify the novel and most effective therapeutic approach to treatment. With this objective, the present review summarizes the evidence supporting the involvement of neurogenic inflammation and neuropeptides in the pathophysiology and pharmacology of migraine headache as well as its potential significance in better tailoring therapeutic interventions in migraine or other neurological disorders. In addition, we have briefly highlighted the pathophysiological role of neurogenic inflammation in various other neurological disorders.
Collapse
Affiliation(s)
- Rakesh Malhotra
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
14
|
García-Martín E, Martínez C, Serrador M, Alonso-Navarro H, Navacerrada F, García-Albea E, Agúndez JAG, Jiménez-Jiménez FJ. Neuronal Nitric Oxide Synthase (nNOS, NOS1) rs693534 and rs7977109 Variants and Risk for Migraine. Headache 2015; 55:1209-17. [PMID: 26283425 DOI: 10.1111/head.12617] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND/OBJECTIVES Many biochemical, pharmacological, neuropathological, and experimental data suggest a possible role of nitric oxide in the pathogenesis of migraine. We investigated the possible association between functional single nucleotide polymorphisms (SNPs) in the neuronal nitric oxide synthase gene (NOS1 or nNOS; chromosome 12q24.22) and the risk for migraine. METHODS We studied the frequency of the of rs7977109 and rs693534 genotypes and allelic variants in 197 patients with migraine and 308 healthy controls using a TaqMan-based qPCR assay. As a secondary analysis, we studied the possible influence of gender, age at onset of migraine, positive family history of migraine, and presence or absence of aura on the genotypes frequency. RESULTS The frequencies of rs7977109 and rs693534 genotypes and allelic variants were not associated with the risk for migraine with OR for minor alleles = 0.94 (95% CI 0.72-1.23) and = 0.88 (0.68-1.15), respectively, and the lack of association was not influenced by gender, age at onset of migraine, positive family history of migraine, and presence or absence of aura. CONCLUSION NOS1 rs7977109 and rs693534 genotypes and allelic variants are not associated with the risk for migraine in Caucasian Spanish people.
Collapse
Affiliation(s)
- Elena García-Martín
- Department of Pharmacology, University of Extremadura, Cáceres, Spain.,Red de Investigación de Reacciones Adversas a Alergenos y Fármacos, Instituto de Salud Carlos III, Madrid, Spain.,AMGenomics, Cáceres, Spain
| | - Carmen Martínez
- Red de Investigación de Reacciones Adversas a Alergenos y Fármacos, Instituto de Salud Carlos III, Madrid, Spain.,Department of Pharmacology, University of Extremadura, Badajoz, Spain
| | - Mercedes Serrador
- Department of Family Medicine, Hospital "Príncipe de Asturias,", Universidad de Alcalá, Madrid, Spain
| | - Hortensia Alonso-Navarro
- Section of Neurology, Hospital Universitario del Sureste, Madrid, Spain.,Department of Medicine-Neurology, Hospital "Príncipe de Asturias,", Universidad de Alcalá, Madrid, Spain
| | - Francisco Navacerrada
- Section of Neurology, Hospital Universitario del Sureste, Madrid, Spain.,Service of Neurology, Hospital "Ramón y Cajal,", Universidad de Alcalá, Madrid, Spain
| | - Esteban García-Albea
- Department of Medicine-Neurology, Hospital "Príncipe de Asturias,", Universidad de Alcalá, Madrid, Spain
| | - José A G Agúndez
- Department of Pharmacology, University of Extremadura, Cáceres, Spain.,Red de Investigación de Reacciones Adversas a Alergenos y Fármacos, Instituto de Salud Carlos III, Madrid, Spain.,AMGenomics, Cáceres, Spain
| | - Félix Javier Jiménez-Jiménez
- Section of Neurology, Hospital Universitario del Sureste, Madrid, Spain.,Department of Medicine-Neurology, Hospital "Príncipe de Asturias,", Universidad de Alcalá, Madrid, Spain
| |
Collapse
|
15
|
Greco R, Ferrigno A, Demartini C, Zanaboni A, Mangione AS, Blandini F, Nappi G, Vairetti M, Tassorelli C. Evaluation of ADMA-DDAH-NOS axis in specific brain areas following nitroglycerin administration: study in an animal model of migraine. J Headache Pain 2015; 16:560. [PMID: 26272684 PMCID: PMC4536246 DOI: 10.1186/s10194-015-0560-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/30/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nitric oxide (NO) is known to play a key role in migraine pathogenesis, but modulation of NO synthesis has failed so far to show efficacy in migraine treatment. Asymmetric dimethylarginine (ADMA) is a NO synthase (NOS) inhibitor, whose levels are regulated by dimethylarginine dimethylaminohydrolase (DDAH). Systemic administration of nitroglycerin (or glyceryl trinitrate, GTN) is a NO donor that consistently induces spontaneous-like headache attacks in migraneurs. GTN administration induces an increase in neuronal NOS (nNOS) that is simultaneous with a hyperalgesic condition. GTN administration has been used for years as an experimental animal model of migraine. In order to gain further insights in the precise mechanisms involved in the relationships between NO synthesis and migraine, we analyzed changes induced by GTN administration in ADMA levels, DDHA-1 mRNA expression and the expression of neuronal and endothelial NOS (nNOS and eNOS) in the brain. We also evaluated ADMA levels in the serum. METHODS Male Sprague-Dawley rats were injected with GTN (10 mg/kg, i.p.) or vehicle and sacrificed 4 h later. Brain areas known to be activated by GTN administration were dissected out and utilized for the evaluation of nNOS and eNOS expression by means of western blotting. Cerebral and serum ADMA levels were measured by means of ELISA immunoassay. Cerebral DDAH-1 mRNA expression was measured by means of RT-PCR. Comparisons between experimental groups were performed using the Mann Whitney test. RESULTS ADMA levels and nNOS expression increased in the hypothalamus and medulla following GTN administration. Conversely, a significant decrease in DDAH-1 mRNA expression was observed in the same areas. By contrast, no significant change was reported in eNOS expression. GTN administration did not induce any significant change in serum levels of ADMA. CONCLUSION The present data suggest that ADMA accumulates in the brain after GTN administration via the inhibition of DDAH-1. This latter may represent a compensatory response to the excessive local availability of NO, released directly by GTN or synthetized by nNOS. These findings prompt an additional mediator (ADMA) in the modulation of NO axis following GTN administration and offer new insights in the pathophysiology of migraine.
Collapse
Affiliation(s)
- Rosaria Greco
- Laboratory of Neurophysiology of Integrative Autonomic Systems, Headache Science Centre, "C. Mondino" National Neurological Institute, Pavia, Italy,
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Neri M, Frustaci A, Milic M, Valdiglesias V, Fini M, Bonassi S, Barbanti P. A meta-analysis of biomarkers related to oxidative stress and nitric oxide pathway in migraine. Cephalalgia 2015; 35:931-7. [DOI: 10.1177/0333102414564888] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 11/16/2014] [Indexed: 01/30/2023]
Abstract
Background Oxidative and nitrosative stress are considered key events in the still unclear pathophysiology of migraine. Methods Studies comparing the level of biomarkers related to nitric oxide (NO) pathway/oxidative stress in the blood/urine of migraineurs vs. unaffected controls were extracted from the PubMed database. Summary estimates of mean ratios (MR) were carried out whenever a minimum of three papers were available. Nineteen studies were included in the meta-analyses, accounting for more than 1000 patients and controls, and compared with existing literature. Results Most studies measuring superoxide dismutase (SOD) showed lower activity in cases, although the meta-analysis in erythrocytes gave null results. On the contrary, plasma levels of thiobarbituric acid reactive substances (TBARS), an aspecific biomarker of oxidative damage, showed a meta-MR of 2.20 (95% CI: 1.65–2.93). As for NOs, no significant results were found in plasma, serum and urine. However, higher levels were shown during attacks, in patients with aura, and an effect of diet was found. The analysis of glutathione precursor homocysteine and asymmetric dimethylarginine (ADMA), an NO synthase inhibitor, gave inconclusive results. Conclusions The role of the oxidative pathway in migraine is still uncertain. Interesting evidence emerged for TBARS and SOD, and concerning the possible role of diet in the control of NOx levels.
Collapse
Affiliation(s)
- Monica Neri
- Clinical and Molecular Epidemiology, Area of Systems Approaches and Non-Communicable Diseases, IRCCS San Raffaele Pisana, Italy
| | - Alessandra Frustaci
- Clinical and Molecular Epidemiology, Area of Systems Approaches and Non-Communicable Diseases, IRCCS San Raffaele Pisana, Italy
| | - Mirta Milic
- Clinical and Molecular Epidemiology, Area of Systems Approaches and Non-Communicable Diseases, IRCCS San Raffaele Pisana, Italy
- Institute for Medical Research and Occupational Health, Mutagenesis Unit, Croatia
| | - Vanessa Valdiglesias
- Clinical and Molecular Epidemiology, Area of Systems Approaches and Non-Communicable Diseases, IRCCS San Raffaele Pisana, Italy
| | | | - Stefano Bonassi
- Clinical and Molecular Epidemiology, Area of Systems Approaches and Non-Communicable Diseases, IRCCS San Raffaele Pisana, Italy
| | - Piero Barbanti
- Headache and Pain Unit, Department of Neurological, Motor and Sensorial Sciences, IRCCS San Raffaele Pisana, Italy
| |
Collapse
|
17
|
Butt JH, Franzmann U, Kruuse C. Endothelial function in migraine with aura - a systematic review. Headache 2014; 55:35-54. [PMID: 25546573 DOI: 10.1111/head.12494] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND An increased risk of ischemic stroke is repeatedly reported in young subjects with migraine with aura (MA). Such may be caused by changes in endothelial function. The present review evaluates current evidence on endothelial function in MA patients. METHODS A systematic search of electronic databases (Medline, Embase, Cochrane library) was performed, and a search in associated reference lists of identified studies was done. RESULTS In total, 27 studies met inclusion criteria for this review. Six studies assessed endothelial function by flow-mediated dilation; four reported no differences compared with healthy subjects, one study reported an increase and one study a decrease in migraineurs. Peripheral arterial tonometry was applied in one study where no changes were detected between groups. Likewise, applying venous occlusion plethysmography elicited comparable responses. Arterial function was investigated in six studies; increased augmentation index and decreased arterial distensibility were reported in migraineurs, whereas findings regarding pulse wave velocity were dissimilar. However, when investigating levels of endothelial progenitor cells, two studies reported reduced levels in migraineurs, and several studies on endothelial markers in the areas of inflammation, oxidative stress, and coagulation found increased endothelial activation in migraineurs, particularly in MA. One study, assessing cerebral endothelial function using transcranial Doppler sonography, reported lower cerebrovascular reactivity to L-arginine in the posterior cerebral arteries in migraineurs. CONCLUSION Endothelial dysfunction appears not to be of importance in MA patients. However, the studies were few with a wide variety of techniques applied in small groups of patients. Endothelial biomarkers were increased in patients indicating a possible subtle change in the endothelium. Further investigations on larger groups of patients combining testing of endothelial dysfunction as well as biomarkers are warranted to identify whether or not endothelial changes may play a role in the increased risk of stroke in young MA patients.
Collapse
Affiliation(s)
- Jawad H Butt
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital Herlev, Herlev, Denmark
| | | | | |
Collapse
|
18
|
Abstract
AIM Migraine has been associated with stroke as well as with several non-atherosclerotic vascular conditions leading to discussions about the potential role of endothelium in the etiopathogenesis of migraine and migraine-associated stroke. We present a systematic review of the literature on vascular biomarkers in migraine, including those suggesting endothelial activation and damage. METHODS We conducted a systematic literature search from 1990 to 2013 using multiple research databases with the keywords "migraine," "headache," "vascular," and "biomarkers." We used selected inclusion and exclusion criteria to create a final pool of studies for this review. RESULTS The literature search identified a total of 639 citations of which 129 were included in our review. The final pool of clinical- and population-based studies assessed the level of various biomarkers (e.g. inflammatory, prothrombotic, endothelial activation, endothelial repair) in migraineurs of varying ages, gender, and demographic characteristics. Although for each biomarker there is at least one study suggesting an association with migraine, in many cases the quality of evidence is poor and there are conflicting studies showing no relationship. The results were, therefore, in each case inconclusive. CONCLUSION This systematic review indicated that in migraine populations there are a number of positive vascular biomarker studies, including some involving novel biomarkers such as endothelial microparticles and endothelial precursor cells. These lend insight into possible pathophysiological mechanisms by which migraine may be associated with stroke. More high-quality studies are needed to establish whether a true association between promising vascular biomarkers and migraine exists.
Collapse
|
19
|
Bernecker C, Ragginer C, Fauler G, Horejsi R, Möller R, Zelzer S, Lechner A, Wallner-Blazek M, Weiss S, Fazekas F, Bahadori B, Truschnig-Wilders M, Gruber HJ. Oxidative stress is associated with migraine and migraine-related metabolic risk in females. Eur J Neurol 2011; 18:1233-9. [PMID: 21518147 DOI: 10.1111/j.1468-1331.2011.03414.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Oxidative stress is discussed to be implicated in the pathophysiology of migraine. However, data are in part controversial and the possible underlying mechanisms remain elusive to date. The aim of this study was to investigate the oxidative stress status of female patients with migraine and its implications on migraine-related metabolic alterations. METHODS Oxidative stress markers malondialdehyde (MDA), 4-hydroxy-2-nonenal (HNE), carbonylated proteins, parameters of associated nitric oxide stress, inflammation, lipid- and glucose-metabolism were determined in the interictal phase in female patients with migraine and controls. RESULTS We found significantly increased HNE levels in female migraineurs compared with controls. Logistic regression analyses of HNE revealed an odds ratio for migraine of 4.55. HNE showed significant correlations with the nitric oxide pathway, the insulin- and the lipid-metabolism. CONCLUSIONS We show here that increased oxidative stress is associated with migraine and contributes to migraine-related metabolic risk like nitrosative stress, an atherogenic lipid profile and hyperinsulinemia. Our data suggest that oxidative stress may represent a key event in the pathophysiology of migraine and a suitable therapeutic target.
Collapse
Affiliation(s)
- C Bernecker
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Uzar E, Evliyaoglu O, Toprak G, Acar A, Yucel Y, Calisir T, Cevik MU, Tasdemir N. Increased asymmetric dimethylarginine and nitric oxide levels in patients with migraine. J Headache Pain 2011; 12:239-43. [PMID: 21359872 PMCID: PMC3072497 DOI: 10.1007/s10194-011-0323-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 11/14/2010] [Indexed: 01/08/2023] Open
Abstract
Asymmetric dimethylarginine (ADMA) has been found as correlated with endothelial dysfunction and oxidative stress. There are few studies regarding ADMA and nitric oxide (NO) levels in patients with migraine and alterations of ADMA and NO levels during migraine attack are not well-known. Therefore, in present study, we aimed to measure NO and ADMA levels in patients with migraine and compare them with the control group to investigate the correlation between migraine, oxidative stress and endothelial dysfunction. The migraine group consisted of 59 patients, including 22 suffering from migraine with aura and 37 suffering from migraine without aura. The control group consisted of 31 healthy volunteers without headache. The patients in migraine group were divided into subgroups based on whether attack period was present or not and whether it was migraine with or without aura. Plasma ADMA levels were measured using an enzyme-linked immunosorbent assay method. Migraine patients had higher concentrations of NO (35.6±7.7, 31.0±6.2 μmol/L, respectively, p=0.005) and ADMA (0.409±0.028, 0.381±0.044 μmol/L, respectively, p = 0.001) levels when compared with the healthy controls. During migraine attack, NO and ADMA levels were found to be significantly higher in migraine group as compared to control group (respectively, p=0.015, p=0.014). Similarly, NO and ADMA levels in the patients with migraine in the interictal period were found to be significantly higher as compared to control group (p=0.011, p=0.003). In conclusion, higher ADMA and NO levels of patients with migraine supported that oxidative stress and endothelial dysfunction may have a role in migraine pathogenesis.
Collapse
Affiliation(s)
- Ertugrul Uzar
- Department of Neurology, Faculty of Medicine, Dicle University School of Medicine, Dicle University, 21280 Diyarbakir, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|