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Marynissen H, Janssen C, Bamps D, de Hoon J. Vascular read-out for TRP channel functionality on distal peripheral nerve endings in healthy men. Microvasc Res 2024; 152:104654. [PMID: 38215901 DOI: 10.1016/j.mvr.2024.104654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/23/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Quantification of the vasodilation after topical application of capsaicin or cinnamaldehyde is often implemented to indirectly assess Transient Receptor Potential (TRP) Vanilloid 1 (TRPV1) or Ankyrin 1 (TRPA1) functionality respectively. This method has been well-established on the human forearm. However, to enable TRP functionality assessments in distal peripheral neuropathy, the vascular response upon TRP activation on dorsal finger skin was characterized. METHODS Two doses of cinnamaldehyde (3 % and 10 % v/v) and capsaicin (300 μg and 1000 μg) were topically applied (20 μL) on the skin of the mid three proximal phalanges in 17 healthy men. The dose-response, and inter-hand and inter-period reproducibility of the dermal blood flow (DBF) increase was assessed using Laser Speckle Contrast Imaging (LSCI) during 60 min post-application. Linear mixed models explored dose-driven differences, whereas the intra-class correlation coefficient (ICC) estimated the reproducibility of the vascular response. RESULTS Both doses of cinnamaldehyde and capsaicin induced a robust, dose-dependent increase in DBF. The vascular response to cinnamaldehyde 10 % on finger skin, expressed as area under the curve, correlated well over time (ICC = 0.66) and excellently between hands (ICC = 0.87). Similarly, the response to capsaicin 1000 μg correlated moderately over time (ICC = 0.50) and well between hands (ICC = 0.73). CONCLUSION The vascular response upon topical cinnamaldehyde and capsaicin application on finger skin is an alternative approach for measurements on forearm skin. Thereby, it is a promising vascular read-out to investigate the pathophysiology, and TRP involvement in particular, of specific peripheral neuropathic pain syndromes.
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Affiliation(s)
- Heleen Marynissen
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Charlien Janssen
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Dorien Bamps
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Jan de Hoon
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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2
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Boinpally R, Shebley M, Trugman JM. Atogepant: Mechanism of action, clinical and translational science. Clin Transl Sci 2024; 17:e13707. [PMID: 38266063 PMCID: PMC10777605 DOI: 10.1111/cts.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/27/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024] Open
Abstract
Since the discovery of calcitonin gene-related peptide (CGRP) in 1982, its integral role in migraine pathophysiology, specifically migraine pain, has been demonstrated through cumulative scientific discoveries that have led to the development and approval of migraine-specific therapeutics. Today, eight drugs, including monoclonal antibodies and small molecule CGRP receptor antagonists, known as gepants, have received approval for acute or preventive treatment of migraine. The primary mechanism of these drugs is to block CGRP signaling, thus preventing CGRP-mediated nociception and neurogenic inflammation. Here, we focus on atogepant, a highly potent and selective gepant and the first and only oral medication approved for the preventive treatment of both episodic and chronic migraine in adults. In this article, we summarize the role of CGRP in migraine pathophysiology and the mechanism of action of atogepant. In addition, we provide an overview of atogepant's pharmacology and the key clinical trials and outcomes that have demonstrated the safety and efficacy of atogepant.
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Boinpally R, Shebley M, Trugman J. Ubrogepant: Mechanism of action, clinical and translational science. Clin Transl Sci 2024; 17:e13675. [PMID: 38266060 PMCID: PMC10777434 DOI: 10.1111/cts.13675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 01/26/2024] Open
Abstract
In recent years, the treatment of migraine has experienced a breakthrough in the development of drugs that target the calcitonin gene-related peptide (CGRP) signaling pathway. Monoclonal antibodies against the receptor or ligand have been developed for the preventive treatment of migraine; whereas, orally administered small molecule CGRP receptor antagonists, called gepants, have been developed for both acute and/or preventive treatment. Both modalities have demonstrated safe and effective treatment of migraine, reducing the number of migraine days for patients as well as reducing symptoms and improving patient function and overall quality of life. Here, we provide an abridged review of ubrogepant, an oral CGRP receptor antagonist, approved for the acute treatment of migraine. We briefly summarize the role of CGRP in migraine pathophysiology, describing the mechanism of action of ubrogepant in the context of this pathway, the clinical pharmacology properties and the clinical development and outcomes, including safety, efficacy, pharmacokinetics, and pharmacodynamics, that supported ubrogepant's approval.
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Affiliation(s)
| | | | - Joel Trugman
- Clinical DevelopmentAbbVieNorth ChicagoIllinoisUSA
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4
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Marynissen H, Mergaerts D, Bamps D, de Hoon J. Does etodolac affect TRPA1 functionality in vivo in human? J Basic Clin Physiol Pharmacol 2023; 34:531-537. [PMID: 36972286 DOI: 10.1515/jbcpp-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/02/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES In preclinical research, etodolac, a non-steroidal anti-inflammatory drug, affected transient receptor potential ankyrin 1 (TRPA1) activation. Yet, whether the in vitro interaction between etodolac and TRPA1 translates to altered TRPA1 functionality in vivo in human remains to be investigated. METHODS A randomized, double-blinded, celecoxib-controlled study was conducted to assess the effect of etodolac on TRPA1-mediated dermal blood flow (DBF) changes on the forearm of 15 healthy, male volunteers aged between 18 and 45 years. Over four study visits, separated by at least five days wash-out, a single or four-fold dose of etodolac 200 mg or celecoxib 200 mg was administered orally. Two hours post-dose, TRPA1 functionality was evaluated by assessing cinnamaldehyde-induced DBF changes. DBF changes were quantified and expressed in Perfusion Units (PUs) using laser Doppler imaging during 60 min post-cinnamaldehyde application. The corresponding area under the curve (AUC0-60min) was calculated as summary measure. Statistical analysis was performed using Linear mixed models with post-hoc Dunnett. RESULTS Neither the single dose of etodolac nor celecoxib inhibited the cinnamaldehyde-induced DBF changes compared to no treatment (AUC0-60min ± SEM of 17,751 ± 1,514 PUs*min and 17,532 ± 1,706 PUs*min vs. 19,274 ± 1,031 PUs*min, respectively, both p=1.00). Similarly, also a four-fold dose of both compounds failed to inhibit the cinnamaldehyde-induced DBF changes (19,235 ± 1,260 PUs*min and 19,367 ± 1,085 PUs*min vs. 19,274 ± 1,031 PUs*min, respectively, both p=1.00). CONCLUSIONS Etodolac did not affect the cinnamaldehyde-induced DBF changes, suggesting that it does not alter TRPA1 functionality in vivo in human.
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Affiliation(s)
- Heleen Marynissen
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Delphine Mergaerts
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Dorien Bamps
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Jan de Hoon
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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5
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González-Hernández A, Marichal-Cancino BA, MaassenVanDenBrink A, Villalón CM. Serotonergic Modulation of Neurovascular Transmission: A Focus on Prejunctional 5-HT Receptors/Mechanisms. Biomedicines 2023; 11:1864. [PMID: 37509503 PMCID: PMC10377335 DOI: 10.3390/biomedicines11071864] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
5-Hydroxytryptamine (5-HT), or serotonin, plays a crucial role as a neuromodulator and/or neurotransmitter of several nervous system functions. Its actions are complex, and depend on multiple factors, including the type of effector or receptor activated. Briefly, 5-HT can activate: (i) metabotropic (G-protein-coupled) receptors to promote inhibition (5-HT1, 5-HT5) or activation (5-HT4, 5-HT6, 5-HT7) of adenylate cyclase, as well as activation (5-HT2) of phospholipase C; and (ii) ionotropic receptor (5-HT3), a ligand-gated Na+/K+ channel. Regarding blood pressure regulation (and beyond the intricacy of central 5-HT effects), this monoamine also exerts direct postjunctional (on vascular smooth muscle and endothelium) or indirect prejunctional (on autonomic and sensory perivascular nerves) effects. At the prejunctional level, 5-HT can facilitate or preclude the release of autonomic (e.g., noradrenaline and acetylcholine) or sensory (e.g., calcitonin gene-related peptide) neurotransmitters facilitating hypertensive or hypotensive effects. Hence, we cannot formulate a specific impact of 5-HT on blood pressure level, since an increase or decrease in neurotransmitter release would be favoured, depending on the type of prejunctional receptor involved. This review summarizes and discusses the current knowledge on the prejunctional mechanisms involved in blood pressure regulation by 5-HT and its impact on some vascular-related diseases.
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Affiliation(s)
- Abimael González-Hernández
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Boulevard Juriquilla 3001, Queretaro 76230, Mexico
| | - Bruno A Marichal-Cancino
- Departamento de Fisiología y Farmacología, Universidad Autónoma de Aguascalientes, Mexico City 20100, Mexico
| | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Carlos M Villalón
- Departamento de Farmacobiología, Cinvestav-Coapa, Calzada de los Tenorios 235, Colonia Granjas-Coapa, Delegación Tlalpan, Mexico City 14330, Mexico
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6
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Al-Hassany L, Karsan N, Lampl C, Goadsby PJ, MaassenVanDenBrink A. Revisiting dose-finding of monoclonal antibodies in migraine. J Headache Pain 2023; 24:69. [PMID: 37296378 DOI: 10.1186/s10194-023-01602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
Migraine is a debilitating disorder, and while the introduction of monoclonal antibodies (mAbs) has led to efficacious and tolerable responses, a substantial number of patients are so-called "non-responders". We introduce reasons for this insufficient response, including insufficient blockade of Calcitonin Gene-Related Peptide (CGRP) or its receptor. We present a clinical case, i.e. a female migraine patient who mistakenly administered supratherapeutic (three-fold higher) doses of erenumab leading to more efficacious clinical responses without any side-effects. This example illustrates that the initial dosages might have been too low, resulting in a remaining undesired increased effect of CGRP. While a capsaicin forearm model has repeatedly been used to evaluate the pharmacokinetic-pharmacodynamic relationship of mAbs, we provide directions to revisit or reconsider dose-finding and dose-ranging of these drugs. These directions include (i) refinement and application of a capsaicin forehead model (instead of a forearm model) to study trigeminovascular activity and improve dosing, and (ii) reconsideration of trial populations. Indeed, the dose-finding studies were mainly performed in relatively young and normal-weight males, while most phase III/IV trials are marked by a high female-to-male ratio, mainly consisting of overweight to obese females. Considering these aspects in future trials could optimize healthcare for a larger proportion of migraine patients.
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Affiliation(s)
- Linda Al-Hassany
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Nazia Karsan
- NIHR SLaM Clinical Research Facility, King's College London, London, UK
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Christian Lampl
- Department of Neurology and Stroke Unit, Koventhospital Barmherzige Brüder Linz, Linz, Austria
- Headache Medical Center Linz, Linz, Austria
| | - Peter J Goadsby
- NIHR SLaM Clinical Research Facility, King's College London, London, UK
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Chang CL, Cai Z, Hsu SYT. Gel-forming antagonist provides a lasting effect on CGRP-induced vasodilation. Front Pharmacol 2022; 13:1040951. [PMID: 36569288 PMCID: PMC9772450 DOI: 10.3389/fphar.2022.1040951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Migraine affects ∼15% of the adult population, and the standard treatment includes the use of triptans, ergotamines, and analgesics. Recently, CGRP and its receptor, the CLR/RAMP1 receptor complex, have been targeted for migraine treatment due to their critical roles in mediating migraine headaches. The effort has led to the approval of several anti-CGRP antibodies for chronic migraine treatment. However, many patients still suffer continuous struggles with migraine, perhaps due to the limited ability of anti-CGRP therapeutics to fully reduce CGRP levels or reach target cells. An alternative anti-CGRP strategy may help address the medical need of patients who do not respond to existing therapeutics. By serendipity, we have recently found that several chimeric adrenomedullin/adrenomedullin 2 peptides are potent CLR/RAMP receptor antagonists and self-assemble to form liquid gels. Among these analogs, the ADE651 analog, which potently inhibits CLR/RAMP1 receptor signaling, forms gels at a 6-20% level. Screening of ADE651 variants indicated that residues at the junctional region of this chimeric peptide are important for gaining the gel-forming capability. Gel-formation significantly slowed the passage of ADE651 molecules through Centricon filters. Consistently, subcutaneous injection of ADE651 gel in rats led to the sustained presence of ADE651 in circulation for >1 week. In addition, analysis of vascular blood flow in rat hindlimbs showed ADE651 significantly reduces CGRP-induced vasodilation. Because gel-forming antagonists could have direct and sustained access to target cells, ADE651 and related antagonists for CLR/RAMP receptors may represent promising candidates for targeting CGRP- and/or adrenomedullin-mediated headaches in migraine patients.
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Affiliation(s)
- Chia Lin Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Zheqing Cai
- CL Laboratory LLC, Gaithersburg, MD, United States
| | - Sheau Yu Teddy Hsu
- Adepthera LLC, San Jose, CA, United States,*Correspondence: Sheau Yu Teddy Hsu,
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8
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Basedau H, Oppermann T, Gundelwein Silva E, Peng KP, May A. Galcanezumab modulates Capsaicin-induced C-fiber reactivity. Cephalalgia 2022; 42:1331-1338. [PMID: 35796521 PMCID: PMC9638712 DOI: 10.1177/03331024221112906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The vasodilatory calcitonin-gene related peptide (CGRP) is understood as
pivotal mediator in migraine pathophysiology. Blocking CGRP with small
molecules or monoclonal antibodies (CGRP-mAb) reduces migraine frequency.
However, prescription of CGRP-mAbs is still regulated and possible
predictive measures of therapeutic success would be useful. Methods Using standardized capsaicin-induced dermal blood flow model, 29 migraine
patients underwent a laser speckle imaging measurement before and after
administration of galcanezumab. At both sessions dermal blood flow before
and after capsaicin stimulation as well as flare size were analyzed over all
three trigeminal branches and the volar forearm for extracranial control.
Long-term measures were repeated in 14 patients after continuous treatment
ranging from 6 to 12 months. Results Resting dermal blood flow remained unchanged after administration of
galcanezumab. Capsaicin-induced dermal blood flow decreased significantly
after CGRP-mAb in all tested areas compared to baseline and this was
consistent even after 12 months of treatment. However, following
galcanezumab administration, the flare size decreased only in the three
trigeminal dermatomes, not the arm and was therefore specific for the
trigemino-vascular system. None of these two markers distinguished between
responders and non-responders. Conclusion CGRP-mAb changed blood flow response to capsaicin stimulation profoundly and
this effect did not change over a 12-month application. Neither
capsaicin-induced flare nor dermal blood flow can be used as a predictor for
treatment efficacy. These data suggest that the mechanism of headache
development in migraine is not entirely CGRP-mediated.
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Affiliation(s)
- Hauke Basedau
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thalea Oppermann
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elisa Gundelwein Silva
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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9
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Tsai SP, Lo JB, Yeung JM, Allen PC, Roberts JA, Hwa GGC. Optimization of capsaicin-induced dermal blood flow measurement by laser Doppler imaging in cynomolgus macaque. J Med Primatol 2021; 50:291-298. [PMID: 34585402 DOI: 10.1111/jmp.12544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/05/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Capsaicin is used in several areas of non-human primate research including allodynia and dermal blood flow (DBF). The capsaicin-induced DBF increase was measured using laser Doppler imaging (LDI), but this response is known to diminish upon repeated topical applications. Refinement of the experimental procedures could improve the rigor and reproducibility of the DBF migraine model. METHODS Optimal anatomical site in cynomolgus was determined, and conditions and experimental settings for DBF measurement using LDI were established. Then, two study design trial structures were compared. RESULTS Medial thigh was the preferrable site, and an ethanol-Tween 20 formulation of capsaicin was desirable. A 1-week washout for contralateral side or 2-week washout for ipsilateral side was necessary to eradicate capsaicin desensitization. CONCLUSIONS With the established technicality in DBF measurements in cynomolgus macaques, the capsaicin-induced DBF model may be utilized in translational medical research in developing migraine therapeutics.
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Affiliation(s)
| | - Jeffrey B Lo
- Valley Biosystems, West Sacramento, California, USA
| | | | | | - Jeffrey A Roberts
- Valley Biosystems, West Sacramento, California, USA.,California National Primate Research Center, Davis, California, USA
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Hijma HJ, Groeneveld GJ. Analgesic drug development: proof-of-mechanism and proof-of-concept in early phase clinical studies. MEDICINE IN DRUG DISCOVERY 2021. [DOI: 10.1016/j.medidd.2021.100083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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11
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Goadsby PJ, Blumenfeld AM, Lipton RB, Dodick DW, Kalidas K, M Adams A, Jakate A, Liu C, Szegedi A, Trugman JM. Time course of efficacy of ubrogepant for the acute treatment of migraine: Clinical implications. Cephalalgia 2021; 41:546-560. [PMID: 33241721 PMCID: PMC8047719 DOI: 10.1177/0333102420970523] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The full utility of an acute treatment requires examination of the entire time course of effect during a migraine attack. Here the time course of effect of ubrogepant is evaluated. METHODS ACHIEVE-I and -II were double-blind, single-attack, Phase 3 trials. Adults with migraine were randomised 1:1:1 to placebo or ubrogepant (50mg or 100mg, ACHIEVE-I; 25 mg or 50 mg, ACHIEVE-II). Pain freedom, absence of most bothersome symptom, and pain relief were assessed at various timepoints. Samples were collected for pharmacokinetic analysis. Data were pooled for this post-hoc analysis. RESULTS Participants' (n = 912 placebo, n = 887 ubrogepant 50 mg, pooled analysis population) mean age was 41 years, with a majority female and white. Pain relief separated from placebo by 1 h (43% versus 37% [OR, 95% CI: 1.30, 1.0-1.59]), absence of most bothersome symptom by 1.5 h (28% versus 22% [1.42, 1.14-1.77]), and pain freedom by 2 h (20% vs. 13% [1.72, 1.33-2.22]). Efficacy was sustained from 2-24 h (pain relief: 1.71, 1.1-2.6; pain freedom: 1.71, 1.3-2.3) and remained separated at 48 h (pain relief: 1.7, 1.1-2.6; pain freedom: 1.31, 1.0-1.7). Pharmacokinetic analysis demonstrated maximum plasma concentrations were achieved at 1 h, with pharmacologically active concentrations reached within 11 min and remaining above the EC90 for nearly 12 h. CONCLUSIONS Evaluation of the time course of effect of ubrogepant showed pain relief as the most sensitive and earliest measure of clinical effect, followed by absence of most bothersome symptom, and pain freedom. Efficacy was demonstrated out to 48 h, providing evidence of the long-lasting effect of ubrogepant. This evaluation supports the role of examining the entire time course of effect to understand fully the utility of an acute treatment for migraine.Trial registration: ACHIEVE I (ClinicalTrials.gov, NCT02828020) and ACHIEVE II (ClinicalTrials.gov, NCT02867709).
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Affiliation(s)
- Peter J Goadsby
- NIHR-Wellcome Trust King’s Clinical Research Facility, SLaM Biomedical Research Centre, King’s College London, London, UK
| | | | - Richard B Lipton
- Albert Einstein College of Medicine and Montefiore Headache Center, Bronx, NY, USA
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12
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Fiedler-Kelly J, Raddad E, de Hoon J, Ludwig EA, Passarell J, Kielbasa W, Collins EC. Relationship of the Calcitonin Gene-Related Peptide Monoclonal Antibody Galcanezumab Pharmacokinetics and Capsaicin-Induced Dermal Blood Flow in Healthy Subjects. Clin Pharmacol Drug Dev 2021; 10:440-452. [PMID: 33740315 DOI: 10.1002/cpdd.929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/02/2021] [Indexed: 11/05/2022]
Abstract
Galcanezumab, a humanized monoclonal antibody targeting calcitonin gene-related peptide, was recently approved for migraine prophylaxis. The pharmacokinetic/pharmacodynamic (PK/PD) relationship between galcanezumab concentration and inhibition of capsaicin-induced dermal blood flow (CIDBF) was evaluated using first-in-human data following 6 single subcutaneous doses (1 to 600 mg) or multiple (4) 150-mg doses every 2 weeks in 7 cohorts (7 actively treated subjects and 2 placebo-treated healthy subjects). Galcanezumab pharmacokinetics were best described by a 1-compartment model with delayed first-order absorption/linear elimination. Apparent estimates (between-subject variability) of clearance, volume of distribution, absorption rate constant, and lag time were 0.0106 L/h (27%CV), 11.2 L (21%CV), 0.0192 h-1 (89%CV), and 0.202 hours, respectively. Estimated elimination half-life was about 30 days. An effect compartment link model described the concentration-effect relationship; estimated maximum inhibitory effect was 70.5%, and 50% maximum inhibitory effect concentration (IC50 ) was 1060 ng/mL. Galcanezumab showed dose- and concentration-dependent potent and durable inhibition of CIDBF. Simulated effect compartment concentrations were maintained above IC50 after 12 weeks of dosing. Near-maximal CIDBF inhibition occurred with 150 mg biweekly for 12 weeks lasting ≥24 weeks or with ≥30 mg every 2 weeks or 195 mg every 13 weeks. Quantitative modeling of galcanezumab PK/PD supported dose selection for the phase 2 proof-of-concept study.
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Affiliation(s)
- Jill Fiedler-Kelly
- Cognigen Corporation, a Simulations Plus company, Buffalo, New York, USA
| | - Eyas Raddad
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Jan de Hoon
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Elizabeth A Ludwig
- Cognigen Corporation, a Simulations Plus company, Buffalo, New York, USA
| | - Julie Passarell
- Cognigen Corporation, a Simulations Plus company, Buffalo, New York, USA
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Bamps D, Vriens J, de Hoon J, Voets T. TRP Channel Cooperation for Nociception: Therapeutic Opportunities. Annu Rev Pharmacol Toxicol 2020; 61:655-677. [PMID: 32976736 DOI: 10.1146/annurev-pharmtox-010919-023238] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic pain treatment remains a sore challenge, and in our aging society, the number of patients reporting inadequate pain relief continues to grow. Current treatment options all have their drawbacks, including limited efficacy and the propensity of abuse and addiction; the latter is exemplified by the ongoing opioid crisis. Extensive research in the last few decades has focused on mechanisms underlying chronic pain states, thereby producing attractive opportunities for novel, effective and safe pharmaceutical interventions. Members of the transient receptor potential (TRP) ion channel family represent innovative targets to tackle pain sensation at the root. Three TRP channels, TRPV1, TRPM3, and TRPA1, are of particular interest, as they were identified as sensors of chemical- and heat-induced pain in nociceptor neurons. This review summarizes the knowledge regarding TRP channel-based pain therapies, including the bumpy road of the clinical development of TRPV1 antagonists, the current status of TRPA1 antagonists, and the future potential of targeting TRPM3.
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Affiliation(s)
- Dorien Bamps
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Joris Vriens
- Laboratory of Endometrium, Endometriosis and Reproductive Medicine, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Jan de Hoon
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, 3000 Leuven, Belgium
| | - Thomas Voets
- Laboratory of Ion Channel Research, VIB-KU Leuven Center for Brain and Disease Research, 3000 Leuven, Belgium; .,Department of Cellular and Molecular Medicine, KU Leuven, 3000 Leuven, Belgium
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Joseph V, Yang X, Gao SS, Elstrott J, Weimer RM, Theess W, Thrasher C, Singh N, Lin J, Bauer RN. Development of AITC-induced dermal blood flow as a translational in vivo biomarker of TRPA1 activity in human and rodent skin. Br J Clin Pharmacol 2020; 87:129-139. [PMID: 32415670 DOI: 10.1111/bcp.14370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/27/2020] [Accepted: 05/01/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND AND PURPOSE Develop a translational assay of Transient Receptor Potential Ankyrin 1 (TRPA1) activity for use as a preclinical and clinical biomarker. EXPERIMENTAL APPROACH Allyl isothiocyanate (AITC), capsaicin or citric acid were applied to ears of wildtype and Trpa1-knock out (Trpa1 KO) rats, and changes in dermal blood flow (DBF) were measured by laser speckle contrast imaging. In humans, the DBF, pain and itch responses to 5-20% AITC applied to the forearm were measured and safety was evaluated. Reproducibility of the DBF, pain and itch responses to topically applied 10% and 15% AITC were assessed at two visits separated by 13-15 days. DBF changes were summarized at 5-minute intervals as areas under the curve (AUC) and maxima. Intraclass correlation coefficient (ICC) was calculated to assess arm-arm and period-period reproducibility. KEY RESULTS AITC- and citric acid-induced DBF were significantly reduced in Trpa1 KO rats compared to wildtype (90 ± 2% and 65 ± 11% reduction, respectively), whereas capsaicin response did not differ. In humans, each AITC concentration significantly increased DBF compared to vehicle with the maximal increase occurring 5 minutes post application. Ten percent and 15% AITC were selected as safe and effective stimuli. AUC from 0 to 5 minutes was the most reproducible metric of AITC-induced DBF across arms (ICC = 0.92) and periods (ICC = 0.85). Subject-reported pain was more reproducible than itch across visits (ICC = 0.76 vs 0.17, respectively). CONCLUSION AND IMPLICATIONS AITC-induced DBF is a suitable target engagement biomarker of TRPA1 activity for preclinical and clinical studies of TRPA1 antagonists.
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Affiliation(s)
- Victory Joseph
- Biomedical Imaging, Genentech, Inc., South San Francisco, CA, USA
| | - Xiaoying Yang
- Biostatistics, Genentech, Inc., South San Francisco, CA, USA
| | - Simon S Gao
- Clinical Imaging, Genentech, Inc., South San Francisco, CA, USA
| | - Justin Elstrott
- Biomedical Imaging, Genentech, Inc., South San Francisco, CA, USA
| | - Robby M Weimer
- Biomedical Imaging, Genentech, Inc., South San Francisco, CA, USA
| | - Wiebke Theess
- Early Clinical Development, Genentech, Inc., South San Francisco, CA, USA
| | - Cory Thrasher
- Environmental Health and Safety, Genentech, Inc., South San Francisco, CA, USA
| | | | - Joseph Lin
- Early Clinical Development, Genentech, Inc., South San Francisco, CA, USA
| | - Rebecca N Bauer
- OMNI Biomarker Development, Genentech, Inc., South San Francisco, CA, USA
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Garcia-Martinez LF, Raport CJ, Ojala EW, Dutzar B, Anderson K, Stewart E, Kovacevich B, Baker B, Billgren J, Scalley-Kim M, Karasek C, Allison D, Latham JA. Pharmacologic Characterization of ALD403, a Potent Neutralizing Humanized Monoclonal Antibody Against the Calcitonin Gene-Related Peptide. J Pharmacol Exp Ther 2020; 374:93-103. [DOI: 10.1124/jpet.119.264671] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022] Open
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Bamps D, Macours L, Buntinx L, de Hoon J. Laser speckle contrast imaging, the future DBF imaging technique for TRP target engagement biomarker assays. Microvasc Res 2020; 129:103965. [DOI: 10.1016/j.mvr.2019.103965] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 12/27/2022]
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18
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Lötsch J, Walter C, Zunftmeister M, Zinn S, Wolters M, Ferreiros N, Rossmanith T, Oertel BG, Geisslinger G. A data science approach to the selection of most informative readouts of the human intradermal capsaicin pain model to assess pregabalin effects. Basic Clin Pharmacol Toxicol 2019; 126:318-331. [PMID: 31608551 DOI: 10.1111/bcpt.13337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/01/2019] [Indexed: 12/29/2022]
Abstract
Persistent and, in particular, neuropathic pain is a major healthcare problem with still insufficient pharmacological treatment options. This triggered research activities aimed at finding analgesics with a novel mechanism of action. Results of these efforts will need to pass through the phases of drug development, in which experimental human pain models are established components e.g. implemented as chemical hyperalgesia induced by capsaicin. We aimed at ranking the various readouts of a human capsaicin-based pain model with respect to the most relevant information about the effects of a potential reference analgesic. In a placebo-controlled, randomized cross-over study, seven different pain-related readouts were acquired in 16 healthy individuals before and after oral administration of 300 mg pregabalin. The sizes of the effect on pain induced by intradermal injection of capsaicin were quantified by calculating Cohen's d. While in four of the seven pain-related parameters, pregabalin provided a small effect judged by values of Cohen's d exceeding 0.2, an item categorization technique implemented as computed ABC analysis identified the pain intensities in the area of secondary hyperalgesia and of allodynia as the most suitable parameters to quantify the analgesic effects of pregabalin. Results of this study provide further support for the ability of the intradermal capsaicin pain model to show analgesic effects of pregabalin. Results can serve as a basis for the designs of studies where the inclusion of this particular pain model and pregabalin is planned.
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Affiliation(s)
- Jörn Lötsch
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany.,Fraunhofer Institute of Molecular Biology and Applied Ecology-Project Group Translational Medicine and Pharmacology, IME-TMP), Frankfurt am Main, Germany
| | - Carmen Walter
- Fraunhofer Institute of Molecular Biology and Applied Ecology-Project Group Translational Medicine and Pharmacology, IME-TMP), Frankfurt am Main, Germany
| | - Martin Zunftmeister
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Sebastian Zinn
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Miriam Wolters
- Fraunhofer Institute of Molecular Biology and Applied Ecology-Project Group Translational Medicine and Pharmacology, IME-TMP), Frankfurt am Main, Germany
| | - Nerea Ferreiros
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany
| | - Tanja Rossmanith
- Fraunhofer Institute of Molecular Biology and Applied Ecology-Project Group Translational Medicine and Pharmacology, IME-TMP), Frankfurt am Main, Germany
| | - Bruno G Oertel
- Fraunhofer Institute of Molecular Biology and Applied Ecology-Project Group Translational Medicine and Pharmacology, IME-TMP), Frankfurt am Main, Germany
| | - Gerd Geisslinger
- Institute of Clinical Pharmacology, Goethe University, Frankfurt am Main, Germany.,Fraunhofer Institute of Molecular Biology and Applied Ecology-Project Group Translational Medicine and Pharmacology, IME-TMP), Frankfurt am Main, Germany
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Lupi C, Guerzoni S, Negro A, Benemei S. Once-monthly galcanezumab for the prevention of migraine in adults: an evidence-based descriptive review and potential place in therapy. Ther Clin Risk Manag 2019; 15:557-569. [PMID: 31043785 PMCID: PMC6469474 DOI: 10.2147/tcrm.s159690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In the last 15 years relevant efforts have been made to demonstrate that calcitonin gene-related peptide (CGRP) antagonism is a valuable and druggable mechanism for treatment or prevention of migraine. Galcanezumab is one of the antibodies developed and studied to prevent migraine by targeting CGRP. The scope of this review is to report data currently available on galcanezumab. According to available data, galcanezumab is safe and efficacious in preventing migraine in episodic migraine patients, also reducing disability and functional impairment due to the disorder. In September 2018, galcanezumab was approved in the USA for the prevention of migraine in adults. The placement of galcanezumab into the current therapeutic scenario will be a revolution for migraine patients, and probably in a less near future also for patients affected by other primary headaches.
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Affiliation(s)
- Chiara Lupi
- Headache Centre, Careggi University Hospital, Department of Health Sciences, University of Florence, Florence, Italy,
| | - Simona Guerzoni
- Medical Toxicology Unit, Headache and Drug Abuse Centre, Department of Biomedical, Metabolic and Neural Sciences, University of Modena e Reggio Emilia, Modena, Italy
| | - Andrea Negro
- Department of Clinical and Molecular Medicine, Regional Referral Headache Centre, Sant'Andrea Hospital, Sapienza University, Rome
| | - Silvia Benemei
- Headache Centre, Careggi University Hospital, Department of Health Sciences, University of Florence, Florence, Italy,
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20
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Cyr MP, Pinard A, Dubois O, Morin M. Reliability of vulvar blood perfusion in women with provoked vestibulodynia using laser Doppler perfusion imaging and laser speckle imaging. Microvasc Res 2019; 121:1-6. [DOI: 10.1016/j.mvr.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/12/2018] [Accepted: 08/08/2018] [Indexed: 11/29/2022]
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21
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de Boer I, Stam AH, Buntinx L, Zielman R, van der Steen I, van den Maagdenberg AMJM, de Koning EJP, Ferrari MD, de Hoon JN, Terwindt GM. RVCL-S and CADASIL display distinct impaired vascular function. Neurology 2018; 91:e956-e963. [PMID: 30076273 DOI: 10.1212/wnl.0000000000006119] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 05/31/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE We aimed to evaluate the role of endothelial-dependent and endothelial-independent vascular reactivity in retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S) and cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), both cerebral small vessel diseases are considered models for stroke, vascular dementia, and migraine. METHODS RVCL-S (n = 18) and CADASIL (n = 23) participants with TREX1 and NOTCH3 mutations, respectively, were compared with controls matched for age, body mass index, and sex (n = 26). Endothelial function was evaluated by flow-mediated vasodilatation, and endothelial-independent vascular reactivity (i.e., vascular smooth muscle cell function) was assessed by dermal blood flow response to capsaicin application. RESULTS Flow-mediated vasodilatation was decreased in participants with RVCL-S compared with controls (2.32% ± 3.83% vs 5.76% ± 3.07% change in diameter, p = 0.023) but normal in participants with CADASIL. Vascular smooth muscle cell function was reduced in participants with CADASIL compared with controls (maximal dermal blood flow increase at 40 minutes after capsaicin: 1.38 ± 0.88 vs 2.22 ± 1.20 arbitrary units, p = 0.010) but normal in participants with RVCL-S. CONCLUSIONS We identified endothelial dysfunction in RVCL-S and confirmed impaired vascular smooth muscle cell relaxation in CADASIL. Our findings may prove to be biomarkers for disease progression in both monogenic cerebral small vessel diseases and improve mechanistic insight in their pathophysiology. This may help in understanding common neurovascular disorders, including stroke, dementia, and migraine.
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Affiliation(s)
- Irene de Boer
- From the Departments of Neurology (I.d.B., A.H.S., R.Z., I.v.d.S., A.M.J.M.v.d.M., M.D.F., G.M.T.), Human Genetics (A.M.J.M.v.d.M.), and Internal Medicine (E.J.P.d.K.), Leiden University Medical Center, Leiden, the Netherlands; and Center for Clinical Pharmacology (L.B., J.N.d.H.), University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Anine H Stam
- From the Departments of Neurology (I.d.B., A.H.S., R.Z., I.v.d.S., A.M.J.M.v.d.M., M.D.F., G.M.T.), Human Genetics (A.M.J.M.v.d.M.), and Internal Medicine (E.J.P.d.K.), Leiden University Medical Center, Leiden, the Netherlands; and Center for Clinical Pharmacology (L.B., J.N.d.H.), University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Linde Buntinx
- From the Departments of Neurology (I.d.B., A.H.S., R.Z., I.v.d.S., A.M.J.M.v.d.M., M.D.F., G.M.T.), Human Genetics (A.M.J.M.v.d.M.), and Internal Medicine (E.J.P.d.K.), Leiden University Medical Center, Leiden, the Netherlands; and Center for Clinical Pharmacology (L.B., J.N.d.H.), University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Ronald Zielman
- From the Departments of Neurology (I.d.B., A.H.S., R.Z., I.v.d.S., A.M.J.M.v.d.M., M.D.F., G.M.T.), Human Genetics (A.M.J.M.v.d.M.), and Internal Medicine (E.J.P.d.K.), Leiden University Medical Center, Leiden, the Netherlands; and Center for Clinical Pharmacology (L.B., J.N.d.H.), University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Iris van der Steen
- From the Departments of Neurology (I.d.B., A.H.S., R.Z., I.v.d.S., A.M.J.M.v.d.M., M.D.F., G.M.T.), Human Genetics (A.M.J.M.v.d.M.), and Internal Medicine (E.J.P.d.K.), Leiden University Medical Center, Leiden, the Netherlands; and Center for Clinical Pharmacology (L.B., J.N.d.H.), University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Arn M J M van den Maagdenberg
- From the Departments of Neurology (I.d.B., A.H.S., R.Z., I.v.d.S., A.M.J.M.v.d.M., M.D.F., G.M.T.), Human Genetics (A.M.J.M.v.d.M.), and Internal Medicine (E.J.P.d.K.), Leiden University Medical Center, Leiden, the Netherlands; and Center for Clinical Pharmacology (L.B., J.N.d.H.), University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Eelco J P de Koning
- From the Departments of Neurology (I.d.B., A.H.S., R.Z., I.v.d.S., A.M.J.M.v.d.M., M.D.F., G.M.T.), Human Genetics (A.M.J.M.v.d.M.), and Internal Medicine (E.J.P.d.K.), Leiden University Medical Center, Leiden, the Netherlands; and Center for Clinical Pharmacology (L.B., J.N.d.H.), University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Michel D Ferrari
- From the Departments of Neurology (I.d.B., A.H.S., R.Z., I.v.d.S., A.M.J.M.v.d.M., M.D.F., G.M.T.), Human Genetics (A.M.J.M.v.d.M.), and Internal Medicine (E.J.P.d.K.), Leiden University Medical Center, Leiden, the Netherlands; and Center for Clinical Pharmacology (L.B., J.N.d.H.), University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Jan N de Hoon
- From the Departments of Neurology (I.d.B., A.H.S., R.Z., I.v.d.S., A.M.J.M.v.d.M., M.D.F., G.M.T.), Human Genetics (A.M.J.M.v.d.M.), and Internal Medicine (E.J.P.d.K.), Leiden University Medical Center, Leiden, the Netherlands; and Center for Clinical Pharmacology (L.B., J.N.d.H.), University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Gisela M Terwindt
- From the Departments of Neurology (I.d.B., A.H.S., R.Z., I.v.d.S., A.M.J.M.v.d.M., M.D.F., G.M.T.), Human Genetics (A.M.J.M.v.d.M.), and Internal Medicine (E.J.P.d.K.), Leiden University Medical Center, Leiden, the Netherlands; and Center for Clinical Pharmacology (L.B., J.N.d.H.), University Hospitals Leuven and Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium.
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22
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Rothenberger J, Wittwer M, Tschumi C, Constantinescu MA, Daigeler A, Olariu R. Quantitative impact analysis of remote ischemic conditioning and capsaicin application on human skin microcirculation. Clin Hemorheol Microcirc 2018; 71:291-298. [PMID: 29914012 DOI: 10.3233/ch-180373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Improvement of skin microcirculation would be beneficial in transplanted tissues and thus, there is a demand for effective, reliable and harmless angiogenic treatments. The aim of this study was to assess the effect of capsaicin application (CA), the remote effect of capsaicin application (REC), the impact of remote ischemic conditioning (RIC), and the impact of combined remote ischemic conditioning with capsaicin application (Comb) on human skin microcirculation. METHODS Perfusion changes were assessed using a laser Doppler device (easyLDI, Aimago Lausanne). 30 healthy volunteers were enrolled and divided into two groups: 1) CA and REC: perfusion was assessed on both forearms after application of capsaicin cream on one forearm with an exposure time of 40 minutes. 2) RIC and Comb: perfusion of one forearm was assessed after four cycles of 5 min blood occlusion and 5 min reperfusion using a tourniquet on the contralateral upper arm and application of capsaicin on the ipsilateral forearm. Baseline skin perfusion measurements of both forearms were carried out initially and were used as intra-individual reference. RESULTS 1) Skin perfusion significantly increased after capsaicin application (CA = +328.3% , p > 0.05). There was no remote skin perfusion change due to capsaicin (REC). 2) RIC significantly improves skin perfusion (RIC = +20.0% , p < 0.05). The combination of RIC and CA does not improve skin perfusion compared to CA alone (Comb). CONCLUSIONS The conditioning techniques RIC and CA showed a significant increase in human skin perfusion, CA being superior to RIC. However, the combination of CA and RIC showed no additional improvement potential as compared to CA alone. Furthermore, a remote effect of capsaicin application could not be demonstrated. These results encourage to analyze if the conditioning treatments are also beneficial for transplanted tissue survival.
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Affiliation(s)
- Jens Rothenberger
- Clinic of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, University Tuebingen, Germany
| | - Matthias Wittwer
- University Clinic of Plastic and Hand Surgery, University Hospital, University of Bern, Inselspital, Switzerland
| | - Christian Tschumi
- University Clinic of Plastic and Hand Surgery, University Hospital, University of Bern, Inselspital, Switzerland
| | - Mihai A Constantinescu
- University Clinic of Plastic and Hand Surgery, University Hospital, University of Bern, Inselspital, Switzerland
| | - Adrien Daigeler
- Clinic of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tuebingen, University Tuebingen, Germany
| | - Radu Olariu
- University Clinic of Plastic and Hand Surgery, University Hospital, University of Bern, Inselspital, Switzerland
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Zugaj D, Chenet A, Petit L, Vaglio J, Pascual T, Piketty C, Bourdes V. A novel image processing workflow for the in vivo quantification of skin microvasculature using dynamic optical coherence tomography. Skin Res Technol 2018; 24:396-406. [PMID: 29399881 DOI: 10.1111/srt.12442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Currently, imaging technologies that can accurately assess or provide surrogate markers of the human cutaneous microvessel network are limited. Dynamic optical coherence tomography (D-OCT) allows the detection of blood flow in vivo and visualization of the skin microvasculature. However, image processing is necessary to correct images, filter artifacts, and exclude irrelevant signals. The objective of this study was to develop a novel image processing workflow to enhance the technical capabilities of D-OCT. MATERIALS AND METHODS Single-center, vehicle-controlled study including healthy volunteers aged 18-50 years. A capsaicin solution was applied topically on the subject's forearm to induce local inflammation. Measurements of capsaicin-induced increase in dermal blood flow, within the region of interest, were performed by laser Doppler imaging (LDI) (reference method) and D-OCT. RESULTS Sixteen subjects were enrolled. A good correlation was shown between D-OCT and LDI, using the image processing workflow. Therefore, D-OCT offers an easy-to-use alternative to LDI, with good repeatability, new robust morphological features (dermal-epidermal junction localization), and quantification of the distribution of vessel size and changes in this distribution induced by capsaicin. The visualization of the vessel network was improved through bloc filtering and artifact removal. Moreover, the assessment of vessel size distribution allows a fine analysis of the vascular patterns. CONCLUSION The newly developed image processing workflow enhances the technical capabilities of D-OCT for the accurate detection and characterization of microcirculation in the skin. A direct clinical application of this image processing workflow is the quantification of the effect of topical treatment on skin vascularization.
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Affiliation(s)
- D Zugaj
- Nestlé Skin Health-Galderma R&D, Sophia Antipolis, Biot, France
| | - A Chenet
- Thales, Sophia Antipolis, Biot, France
| | - L Petit
- Nestlé Skin Health-Galderma R&D, Sophia Antipolis, Biot, France
| | - J Vaglio
- Nestlé Skin Health-Galderma R&D, Sophia Antipolis, Biot, France
| | - T Pascual
- Nestlé Skin Health-Galderma R&D, Sophia Antipolis, Biot, France
| | - C Piketty
- Nestlé Skin Health-Galderma R&D, Sophia Antipolis, Biot, France
| | - V Bourdes
- Nestlé Skin Health-Galderma R&D, Sophia Antipolis, Biot, France
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Monteith D, Collins EC, Vandermeulen C, Van Hecken A, Raddad E, Scherer JC, Grayzel D, Schuetz TJ, de Hoon J. Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of the CGRP Binding Monoclonal Antibody LY2951742 (Galcanezumab) in Healthy Volunteers. Front Pharmacol 2017; 8:740. [PMID: 29089894 PMCID: PMC5651004 DOI: 10.3389/fphar.2017.00740] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/02/2017] [Indexed: 01/07/2023] Open
Abstract
Background: Calcitonin gene-related peptide (CGRP) is pivotal in the pathophysiology of migraine headaches and represents a promising target for migraine treatment. The humanized monoclonal antibody galcanezumab (LY2951742) binds to CGRP and may be effective in migraine prophylaxis. Objectives: The primary objective was to evaluate the safety and tolerability of single and multiple doses of galcanezumab in humans. Secondary objectives included assessing the pharmacokinetics and evaluating target engagement. Methods: A double-blind, randomized, placebo-controlled study (NCT 01337596) with single escalating and multiple subcutaneous (SC) doses of galcanezumab was performed in healthy male volunteers. Single doses of 1, 5, 25, 75, 200, and 600 mg of galcanezumab (n = 7/dose) or placebo (n = 2/dose) were injected SC in six consecutive cohorts of nine subjects each. One cohort of nine subjects received multiple (4) 150 mg doses of galcanezumab or placebo every other week. Target engagement was evaluated by measuring inhibition of capsaicin-induced increase in dermal blood flow (DBF). Findings: Sixty-three subjects were randomized and included in the safety analyses. Galcanezumab was well tolerated in single doses (1–600 mg SC) and consecutive doses (150 mg SC). There was no dose-dependent difference in type or frequency of treatment-emergent adverse events, and no clinically meaningful difference when compared with placebo. Pharmacokinetics were linear. Galcanezumab induced a robust, dose-dependent, and durable inhibition of capsaicin-induced increase in DBF, supporting the continued clinical development of galcanezumab for prophylaxis in migraine patients.
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Affiliation(s)
- David Monteith
- Eli Lilly and Company, Indianapolis, IN, United States.,Omeros Corporation, Seattle, WA, United States
| | | | - Corinne Vandermeulen
- Center for Clinical Pharmacology, University Hospitals of Leuven, KU Leuven, Leuven, Belgium
| | - Anne Van Hecken
- Center for Clinical Pharmacology, University Hospitals of Leuven, KU Leuven, Leuven, Belgium
| | - Eyas Raddad
- Eli Lilly and Company, Indianapolis, IN, United States
| | | | - David Grayzel
- Arteaus Therapeutics, LLC, Cambridge, MA, United States
| | | | - Jan de Hoon
- Center for Clinical Pharmacology, University Hospitals of Leuven, KU Leuven, Leuven, Belgium
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Vu T, Ma P, Chen JS, de Hoon J, Van Hecken A, Yan L, Wu LS, Hamilton L, Vargas G. Pharmacokinetic-Pharmacodynamic Relationship of Erenumab (AMG 334) and Capsaicin-Induced Dermal Blood Flow in Healthy and Migraine Subjects. Pharm Res 2017; 34:1784-1795. [PMID: 28593473 PMCID: PMC5533838 DOI: 10.1007/s11095-017-2183-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/15/2017] [Indexed: 01/16/2023]
Abstract
Purpose Capsaicin-induced dermal blood flow (CIDBF) is a validated biomarker used to evaluate the target engagement of potential calcitonin gene-related peptide-blocking therapeutics for migraine. To characterize the pharmacokinetics (PK) and quantify the inhibitory effects of erenumab (AMG 334) on CIDBF, CIDBF data were pooled from a single- and a multiple-dose study in healthy and migraine subjects. Methods Repeated capsaicin challenges and DBF measurements were performed and serum erenumab concentrations determined. A population analysis was conducted using a nonlinear mixed-effects modeling approach. Effects of body weight, gender, and age on model parameters were evaluated. Results Two-compartment target-mediated drug disposition (TMDD) model assuming binding of erenumab in the central compartment best described the nonlinear PK of erenumab. Subcutaneous absorption half-life was 1.6 days and bioavailability was 74%. Erenumab produced a maximum inhibition of 89% (95% confidence interval: 87–91%). Erenumab concentrations required for 50% and 99% of maximum inhibition were 255 ng/mL and 1134 ng/mL, respectively. Increased body weight was associated with increased erenumab clearance but had no effect on the inhibitory effect on CIDBF. Conclusions Our results show that erenumab pharmacokinetics was best characterized by a TMDD model and resulted in potent inhibition of CIDBF. Electronic supplementary material The online version of this article (doi:10.1007/s11095-017-2183-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thuy Vu
- Clinical Pharmacology, Modeling and Simulation, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California, 91320-1799, USA.
| | - Peiming Ma
- Clinical Pharmacology, GSK R&D, Shanghai, China
| | | | - Jan de Hoon
- Center for Clinical Pharmacology, University Hospitals of Leuven, Leuven, Belgium
| | - Anne Van Hecken
- Center for Clinical Pharmacology, University Hospitals of Leuven, Leuven, Belgium
| | - Lucy Yan
- Clinical Pharmacology, Modeling and Simulation, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California, 91320-1799, USA
| | - Liviawati Sutjandra Wu
- Clinical Pharmacology, Modeling and Simulation, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California, 91320-1799, USA
| | - Lisa Hamilton
- Global Biostatistical Sciences, Amgen Limited, Uxbridge, England, UK
| | - Gabriel Vargas
- Clinical Pharmacology, Modeling and Simulation, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California, 91320-1799, USA
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Bogen KT, Singhal A. Malathion dermal permeability in relation to dermal load: Assessment by physiologically based pharmacokinetic modeling of in vivo human data. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART. B, PESTICIDES, FOOD CONTAMINANTS, AND AGRICULTURAL WASTES 2017; 52:138-146. [PMID: 27820679 DOI: 10.1080/03601234.2016.1248150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/09/2016] [Indexed: 06/06/2023]
Abstract
Estimates of dermal permeability (Kp), obtained by fitting an updated human PBPK model for malathion to previously reported data on excreted urinary metabolites after 29 volunteers were dermally exposed to measured values of [14C]malathion dermal load (L), were used to examine the empirical relationship between Kp and L. The PBPK model was adapted from previously reported human biokinetic and PBPK models for malathion, fit to previously reported urinary excretion data after oral [14C]malathion intake by volunteers, and then augmented to incorporate a standard Kp approach to modeling dermal-uptake kinetics. Good to excellent PBPK-model fits were obtained to all of 29 sets of cumulative urinary metabolite-excretion data (ave. [±1 SD] R2 = 0.953 [±0.064]). Contrary to the assumption that Kp and L are independent typically applied for dermally administered liquids or solutions, the 29 PBPK-based estimates of Kp obtained for malathion exhibit a strong positive association with the 2/3rds power of L (log-log Pearson correlation = 0.925, p = ∼0). Possible explanations of this observation involving physico-chemical characteristics and/or in vivo cutaneous effects of malathion are discussed. The PBPK model presented, and our observation that Kp estimates obtained by fitting this model to human experimental urinary-excretion data correlate well with L2/3, allow more realistic assessments of absorbed and metabolized dose during or after a variety of scenarios involving actual or potential dermal or multi-route malathion exposures, including for pesticide workers or farmers who apply malathion to crops.
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Affiliation(s)
| | - Ankur Singhal
- a Exponent Health Sciences , Oakland , California , USA
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TRPV1 antagonist JNJ-39439335 (mavatrep) demonstrates proof of pharmacology in healthy men: a first-in-human, double-blind, placebo-controlled, randomized, sequential group study. Pain Rep 2016; 1:e576. [PMID: 29392196 PMCID: PMC5741288 DOI: 10.1097/pr9.0000000000000576] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 09/02/2016] [Accepted: 09/12/2016] [Indexed: 11/26/2022] Open
Abstract
This double-blind, randomized, placebo-controlled, sequential group, phase 1 study was designed to assess in healthy men, the safety, tolerability, pharmacokinetics, and translational pharmacodynamics of JNJ-39439335 (mavatrep), a transient receptor potential vanilloid subtype 1 antagonist; it was preceded by a translational preclinical study which assessed the ability of JNJ-39439335 to block capsaicin-induced flare in rats, providing predictive pharmacokinetic and pharmacodynamic data that informed the subsequent phase 1 clinical study. The clinical study consisted of 2 parts: part 1 assessed pharmacokinetics and pharmacodynamics, including heat pain detection threshold and heat pain tolerance, of JNJ-39439335, and part 2 assessed pharmacodynamic effect of JNJ-39439335 on capsaicin-induced flare and sensory testing on naïve and UVB-sensitized skin in humans. Plasma concentrations of JNJ-39439335 peaked at approximately 2 to 4 hours postdose, then declined multiexponentially, with a prolonged terminal phase (half-life: 30-86 hours). Renal clearance of JNJ-39439335 was negligible. JNJ-39439335 treatment resulted in clear, consistent dose-related increases in heat pain detection threshold, heat pain tolerance, and heat pain latency. JNJ-39439335 reduced the capsaicin-induced flare area and flare intensity, with complete blocking observed in the 50-mg dose group at 144 hours postdose. This was consistent with the capsaicin flare results observed with JNJ-39439335 in rats. The most common adverse events observed in the clinical study were related to increases in body temperature after JNJ-39439335 treatment; these were predominately mild to moderate in severity with no evidence of exposure dependence up to 225 mg. JNJ-39439335 was well tolerated at single doses up to 225 mg, recommending its suitability for further clinical development.
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Buntinx L, Voets T, Morlion B, Vangeel L, Janssen M, Cornelissen E, Vriens J, de Hoon J, Levtchenko E. TRPV1 dysfunction in cystinosis patients harboring the homozygous 57 kb deletion. Sci Rep 2016; 6:35395. [PMID: 27734949 PMCID: PMC5062165 DOI: 10.1038/srep35395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/27/2016] [Indexed: 11/12/2022] Open
Abstract
Cystinosis is a rare autosomal recessive disorder characterized by lysosomal cystine accumulation due to loss of function of the lysosomal cystine transporter (CTNS). The most common mutation in cystinosis patients of Northern Europe consists of a 57-kb deletion. This deletion not only inactivates the CTNS gene but also extends into the non-coding region upstream of the start codon of the TRPV1 gene, encoding the capsaicin- and heat-sensitive ion channel TRPV1. To evaluate the consequences of the 57-kb deletion on functional TRPV1 expression, we compared thermal, mechanical and chemical sensitivity of cystinosis patients with matched healthy controls. Whereas patients heterozygous for the 57-kb deletion showed normal sensory responses, homozygous subjects exhibited a 60% reduction in vasodilation and pain evoked by capsaicin, as well as an increase in heat detection threshold. Responses to cold, mechanical stimuli or cinnamaldehyde, an agonist of the related nociceptor channel TRPA1, were unaltered. We conclude that cystinosis patients homozygous for the 57-kb deletion exhibit a strong reduction of TRPV1 function, leading to sensory deficiencies akin to the phenotype of TRPV1-deficient mice. These deficits may account for the reported sensory alterations and thermoregulatory deficits in these patients, and provide a paradigm for life-long TRPV1 deficiency in humans.
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Affiliation(s)
- L Buntinx
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KULeuven, Herestraat 49, 3000 Leuven, Belgium
| | - T Voets
- Department of Cellular and Molecular Medicine, KULeuven, Herestraat 49, 3000 Leuven, Belgium
| | - B Morlion
- Center for algology and pain management, Department of Cardiovascular Sciences, KULeuven, Weligerveld 1, 3212 Pellenberg, Belgium
| | - L Vangeel
- Department of Cellular and Molecular Medicine, KULeuven, Herestraat 49, 3000 Leuven, Belgium
| | - M Janssen
- Department of internal medicine, Radboud UMC Nijmegen, Geert Grooteplein-Zuid 22, 6525 GA Nijmegen, The Netherlands
| | - E Cornelissen
- Department of Pediatric Nephrology, Radboud UMC Nijmegen, Geert Grooteplein-Zuid 22, 6525 GA Nijmegen, The Netherlands
| | - J Vriens
- Department of Development and Regeneration, KULeuven, Herestraat 49, 3000 Leuven, Belgium
| | - J de Hoon
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KULeuven, Herestraat 49, 3000 Leuven, Belgium
| | - E Levtchenko
- Department of Development and Regeneration, KULeuven, Herestraat 49, 3000 Leuven, Belgium
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Ibrahimi K, Vermeersch S, Frederiks P, Geldhof V, Draulans C, Buntinx L, Lesaffre E, MaassenVanDenBrink A, de Hoon J. The influence of migraine and female hormones on capsaicin-induced dermal blood flow. Cephalalgia 2016; 37:1164-1172. [PMID: 27687880 DOI: 10.1177/0333102416668659] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background Migraine is much more common in females than in males, and occurrence is associated with changes in female sex hormones. Calcitonin gene-related peptide (CGRP) plays a key role in migraine, and variations in female sex hormones may affect CGRP sensitivity and/or production. Objectives Investigate repeatability, gender differences, influence of the menstrual cycle and of migraine on CGRP-dependent changes in dermal blood flow (DBF). Methods CGRP-dependent increases in DBF were assessed using laser Doppler perfusion imaging after topical application of 300 or 1000 µg capsaicin on the forearm of healthy subjects and migraine patients. Results In healthy males, DBF response did not vary over time and was comparable with DBF in male migraineurs. In healthy females, capsaicin-induced DBF responses to both doses of capsaicin were higher during menstruation compared to the late-secretory phase (p < 0.05); this menstrual cycle dependence was absent in female migraine patients. Compared to healthy subjects, female migraineurs displayed a higher DBF response both during menstruation and during the late-secretory phase (p < 0.05). Conclusions An increased capsaicin-induced, CGRP-mediated DBF response was observed during menstruation in healthy women, but in female migraine patients this increased response was not affected by the menstrual cycle.
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Affiliation(s)
- Khatera Ibrahimi
- 1 Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Steve Vermeersch
- 2 Center for Clinical Pharmacology, University Hospitals Leuven & Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Pascal Frederiks
- 2 Center for Clinical Pharmacology, University Hospitals Leuven & Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Vincent Geldhof
- 2 Center for Clinical Pharmacology, University Hospitals Leuven & Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Cedric Draulans
- 2 Center for Clinical Pharmacology, University Hospitals Leuven & Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Linde Buntinx
- 2 Center for Clinical Pharmacology, University Hospitals Leuven & Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
| | - Emmanuel Lesaffre
- 3 Leuven Biostatistics and Statistical Bioinformatics Centre, Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Antoinette MaassenVanDenBrink
- 1 Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan de Hoon
- 2 Center for Clinical Pharmacology, University Hospitals Leuven & Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Belgium
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Li CC, Vermeersch S, Denney WS, Kennedy WP, Palcza J, Gipson A, Han TH, Blanchard R, De Lepeleire I, Depré M, Murphy MG, Van Dyck K, de Hoon JN. Characterizing the PK/PD relationship for inhibition of capsaicin-induced dermal vasodilatation by MK-3207, an oral calcitonin gene related peptide receptor antagonist. Br J Clin Pharmacol 2016; 79:831-7. [PMID: 25377933 DOI: 10.1111/bcp.12547] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 10/30/2014] [Indexed: 11/28/2022] Open
Abstract
AIMS Calcitonin gene related peptide (CGRP) receptor antagonists are effective acute migraine treatments. A capsaicin-induced dermal vasodilatation (CIDV) model has been developed to provide target-engagement information in healthy volunteers. In the model, CGRP release is provoked after dermal capsaicin application, by activating transient receptor potential vanilloid-type-1 (TRPV1) receptors at peripheral sensory nerves. Laser Doppler imaging is used to quantify CIDV and subsequent inhibition by CGRP receptor antagonists. We sought to evaluate a CGRP receptor antagonist, MK-3207, in the biomarker model and to assess the predictability of the CIDV response to migraine clinical efficacy. METHODS An integrated population pharmacokinetic/pharmacodynamic (PK/PD) model was developed to describe the exposure-response relationship for CIDV inhibition by CGRP and TRPV1 receptor antagonists. MK-3207 dose-response predictions were made based on estimated potency from the PK/PD model and mean plasma concentrations observed at the doses investigated. RESULTS The results suggested that a 20 mg dose of MK-3207 (EC50 of 1.59 nm) would be required to attain the peripheral CIDV response at a target level that was shown previously to correlate with 2 h clinical efficacy based on phase 3 telcagepant clinical data, and that a plateau of the dose-response would be reached around 40-100 mg. These predictions provided a quantitative rationale for dose selection in a phase 2 clinical trial of MK-3207 and helped with interpretation of the efficacy results from the trial. CONCLUSIONS The integrated CIDV PK/PD model provides a useful platform for characterization of PK/PD relationships and predictions of dose-response relationships to aid in future development of CGRP and TRPV1 receptor antagonists.
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Affiliation(s)
- Chi-Chung Li
- Merck Research Laboratories, Merck & Co., Inc., Whitehouse Station, NJ, USA
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Buntinx L, Vermeersch S, de Hoon J. Development of anti-migraine therapeutics using the capsaicin-induced dermal blood flow model. Br J Clin Pharmacol 2015; 80:992-1000. [PMID: 26114340 DOI: 10.1111/bcp.12704] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 06/02/2015] [Accepted: 06/16/2015] [Indexed: 12/30/2022] Open
Abstract
The efficacy of calcitonin gene-related peptide (receptor) (CGRP-(R)) blocking therapeutics in the treatment of acute migraine headache provided proof-of-concept for the involvement of CGRP in the pathophysiology of this disorder. One of the major hurdles for the development of any class of drugs, including CGRP blocking therapeutics, is the early clinical development process during which toxic and inefficacious compounds need to be eliminated as early as possible in order to focus on the most promising molecules. At this stage, human models providing proof of target engagement, combined with safety and tolerability studies, are extremely valuable in focusing on those therapeutics that have the highest engagement from the lowest exposure. They guide the go/no-go decision making, establish confidence in the candidate molecule by de-risking toxicity and safety issues and thereby speed up the early clinical development. In this review the focus is on the so called 'capsaicin model' as a typical example of a target engagement biomarker used as a human model for the development of CGRP blocking therapeutics. By applying capsaicin onto the skin, TRPV1 channels are activated and a CGRP-mediated increase in dermal blood flow can be quantified with laser Doppler perfusion imaging. Effective CGRP blocking therapeutics in turn, display blockade of this response. The translation of this biomarker model from animals to humans is discussed as well as the limitations of the assay in predicting the efficacy of anti-migraine drugs.
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Affiliation(s)
- Linde Buntinx
- Centre for Clinical Pharmacology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Steve Vermeersch
- Centre for Clinical Pharmacology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Jan de Hoon
- Centre for Clinical Pharmacology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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The metabolic effects of a commercially available chicken peri-peri (African bird's eye chilli) meal in overweight individuals. Br J Nutr 2015; 117:635-644. [PMID: 26360825 DOI: 10.1017/s0007114515003104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A growing body of evidence suggests that capsaicin ingestion may lead to desirable metabolic outcomes; however, the results in humans are equivocal. Whether or not benefits may be gained from ingestion of capsaicin via a commercially available meal has not been determined. The objectives of this randomised, cross-over intervention study were to compare the 2 h postprandial effects of a standard commercially prepared meal containing chilli (HOT, 5·82 mg total capsaicinoids) with a similar meal with no chilli (CON, 25 kg/m2 and a waist circumference >94 cm (men) or 80 cm (women), were studied. Participants had normal glucose tolerance and were accustomed, but were not regular chilli eaters. A paired t test indicated that insulin AUC was smaller following the HOT meal (P=0·002). Similarly, there was a tendency for glucose AUC to be reduced following the HOT meal (P=0·056). No discernable effects of the HOT meal were observed on metabolic rate, core temperature, hs-CRP concentrations and endothelial-dependent microvascular reactivity. The results from this study indicate that a standard restaurant meal containing a relatively small dose of capsaicin delivered via African bird's eye chilli, which is currently available to the public, results in lower postprandial insulin concentrations in overweight individuals, compared with the same meal without chilli.
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Vermeersch S, Benschop RJ, Van Hecken A, Monteith D, Wroblewski VJ, Grayzel D, de Hoon J, Collins EC. Translational Pharmacodynamics of Calcitonin Gene-Related Peptide Monoclonal Antibody LY2951742 in a Capsaicin-Induced Dermal Blood Flow Model. J Pharmacol Exp Ther 2015; 354:350-7. [PMID: 26116630 DOI: 10.1124/jpet.115.224212] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/26/2015] [Indexed: 01/06/2023] Open
Abstract
LY2951742, a monoclonal antibody targeting calcitonin gene-related peptide (CGRP), is being developed for migraine prevention and osteoarthritis pain. To support the clinical development of LY2951742, capsaicin-induced dermal blood flow (DBF) was used as a target engagement biomarker to assess CGRP activity in nonhuman primates and healthy volunteers. Inhibition of capsaicin-induced DBF in nonhuman primates, measured with laser Doppler imaging, was dose dependent and sustained for at least 29 days after a single intravenous injection of the CGRP antibody. This information was used to generate a pharmacokinetic/pharmacodynamic model, which correctly predicted inhibition of capsaicin-induced DBF in humans starting at a single subcutaneous 5-mg dose. As expected, the degree of inhibition in capsaicin-induced DBF increased with higher LY2951742 plasma concentrations. Utilization of this pharmacodynamic biomarker with pharmacokinetic data collected in phase I studies provided the dose-response relationship that assisted in dose selection for the phase II clinical development of LY2951742.
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Affiliation(s)
- Steve Vermeersch
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven and University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium (S.V., A.V.H., J.d.H.); Eli Lilly and Company, Indianapolis, Indiana (R.J.B., D.M., V.J.W., E.C.C.); and Atlas Venture, Cambridge, Massachusetts (D.G.)
| | - Robert J Benschop
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven and University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium (S.V., A.V.H., J.d.H.); Eli Lilly and Company, Indianapolis, Indiana (R.J.B., D.M., V.J.W., E.C.C.); and Atlas Venture, Cambridge, Massachusetts (D.G.)
| | - Anne Van Hecken
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven and University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium (S.V., A.V.H., J.d.H.); Eli Lilly and Company, Indianapolis, Indiana (R.J.B., D.M., V.J.W., E.C.C.); and Atlas Venture, Cambridge, Massachusetts (D.G.)
| | - David Monteith
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven and University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium (S.V., A.V.H., J.d.H.); Eli Lilly and Company, Indianapolis, Indiana (R.J.B., D.M., V.J.W., E.C.C.); and Atlas Venture, Cambridge, Massachusetts (D.G.)
| | - Victor J Wroblewski
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven and University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium (S.V., A.V.H., J.d.H.); Eli Lilly and Company, Indianapolis, Indiana (R.J.B., D.M., V.J.W., E.C.C.); and Atlas Venture, Cambridge, Massachusetts (D.G.)
| | - David Grayzel
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven and University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium (S.V., A.V.H., J.d.H.); Eli Lilly and Company, Indianapolis, Indiana (R.J.B., D.M., V.J.W., E.C.C.); and Atlas Venture, Cambridge, Massachusetts (D.G.)
| | - Jan de Hoon
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven and University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium (S.V., A.V.H., J.d.H.); Eli Lilly and Company, Indianapolis, Indiana (R.J.B., D.M., V.J.W., E.C.C.); and Atlas Venture, Cambridge, Massachusetts (D.G.)
| | - Emily C Collins
- Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven and University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium (S.V., A.V.H., J.d.H.); Eli Lilly and Company, Indianapolis, Indiana (R.J.B., D.M., V.J.W., E.C.C.); and Atlas Venture, Cambridge, Massachusetts (D.G.)
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Bell IM. Calcitonin Gene-Related Peptide Receptor Antagonists: New Therapeutic Agents for Migraine. J Med Chem 2014; 57:7838-58. [DOI: 10.1021/jm500364u] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Ian M. Bell
- Department of Discovery Chemistry,
Merck Research Laboratories, West
Point, Pennsylvania 19486, United States
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Benschop RJ, Collins EC, Darling RJ, Allan BW, Leung D, Conner EM, Nelson J, Gaynor B, Xu J, Wang XF, Lynch RA, Li B, McCarty D, Nisenbaum ES, Oskins JL, Lin C, Johnson KW, Chambers MG. Development of a novel antibody to calcitonin gene-related peptide for the treatment of osteoarthritis-related pain. Osteoarthritis Cartilage 2014; 22:578-85. [PMID: 24508775 DOI: 10.1016/j.joca.2014.01.009] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/17/2014] [Accepted: 01/25/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Investigate a role for calcitonin gene-related peptide (CGRP) in osteoarthritis (OA)-related pain. DESIGN Neutralizing antibodies to CGRP were generated de novo. One of these antibodies, LY2951742, was characterized in vitro and tested in pre-clinical in vivo models of OA pain. RESULTS LY2951742 exhibited high affinity to both human and rat CGRP (KD of 31 and 246 pM, respectively). The antibody neutralized CGRP-mediated induction of cAMP in SK-N-MC cells in vitro and capsaicin-induced dermal blood flow in the rat. Neutralization of CGRP significantly reduced pain behavior as measured by weight bearing differential in the rat monoiodoacetate model of OA pain in a dose-dependent manner. Moreover, pain reduction with neutralization of CGRP occurred independently of prostaglandins, since LY2951742 and NSAIDs worked additively in the NSAID-responsive version of the model and CGRP neutralization remained effective in the NSAID non-responsive version of the model. Neutralization of CGRP also provided dose-dependent and prolonged (>60 days) pain reduction in the rat meniscal tear model of OA after only a single injection of LY2951742. CONCLUSIONS LY2951742 is a high affinity, neutralizing antibody to CGRP. Neutralization of CGRP is efficacious in several OA pain models and works independently of NSAID mechanisms of action. LY2951742 holds promise for the treatment of pain in OA patients.
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Affiliation(s)
- R J Benschop
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - E C Collins
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - R J Darling
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - B W Allan
- Eli Lilly & Company, Lilly Biotechnology Center, San Diego, CA 92121, USA.
| | - D Leung
- Eli Lilly & Company, Lilly Biotechnology Center, San Diego, CA 92121, USA.
| | - E M Conner
- Eli Lilly & Company, Lilly Biotechnology Center, San Diego, CA 92121, USA.
| | - J Nelson
- Eli Lilly & Company, Lilly Biotechnology Center, San Diego, CA 92121, USA.
| | - B Gaynor
- Eli Lilly & Company, Lilly Biotechnology Center, San Diego, CA 92121, USA.
| | - J Xu
- Eli Lilly & Company, Lilly Biotechnology Center, San Diego, CA 92121, USA.
| | - X-F Wang
- Eli Lilly & Company, Lilly Biotechnology Center, San Diego, CA 92121, USA.
| | - R A Lynch
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - B Li
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - D McCarty
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - E S Nisenbaum
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | | | - C Lin
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - K W Johnson
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| | - M G Chambers
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
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Ibrahimi K, Vermeersch S, Danser A, Villalón CM, van den Meiracker AH, de Hoon J, MaassenVanDenBrink A. Development of an experimental model to study trigeminal nerve-mediated vasodilation on the human forehead. Cephalalgia 2014; 34:514-22. [PMID: 24391116 DOI: 10.1177/0333102413517773] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 11/20/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND During migraine, trigeminal sensory nerve terminals release calcitonin gene-related peptide (CGRP), inducing nociception and vasodilation. Applied on the skin, capsaicin activates the transient receptor potential vanilloid type 1 (TRPV1) channel and releases CGRP from sensory nerve terminals, thus increasing dermal blood flow (DBF). Using capsaicin application and electrical stimulation of the forehead skin, a trigeminal nerve-innervated dermatome, we aimed to develop a model to measure trigeminal nerve-mediated vasodilation in humans. METHODS Using laser Doppler imaging, forehead DBF responses to application of capsaicin (0.06 mg/ml and 6.0 mg/ml) and saline, with and without iontophoresis, were studied in healthy subjects. The within-subject coefficient of variation (WCV) of repeated DBF measurements was calculated to assess reproducibility. RESULTS Maximal DBF responses to 6.0 mg/ml capsaicin with and without iontophoresis did not differ (Emax 459 ± 32 and 424 ± 32 arbitrary units (a.u.), WCV 6 ± 4%). In contrast, DBF responses to 0.06 mg/ml capsaicin were significantly larger with than without iontophoresis (Emax 307 ± 60 versus 187 ± 21 a.u., WCV 21 ± 13%). Saline with iontophoresis significantly increased DBF (Emax: 245 ± 26 a.u, WCV 11 ± 8%), while saline application without iontophoresis did not affect DBF. CONCLUSION Topical application of capsaicin and electrical stimulation induce reproducible forehead DBF increases and therefore are suitable to study trigeminal nerve-mediated vasodilation in humans.
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Affiliation(s)
- K Ibrahimi
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, the Netherlands
| | - S Vermeersch
- Center for Clinical Pharmacology, University Hospital Gasthuisberg (KU Leuven), Belgium
| | - Ahj Danser
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, the Netherlands
| | - C M Villalón
- Departamento de Farmacobiología, Cinvestav-Coapa, México
| | - A H van den Meiracker
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, the Netherlands
| | - J de Hoon
- Center for Clinical Pharmacology, University Hospital Gasthuisberg (KU Leuven), Belgium
| | - A MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, the Netherlands
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Labruijere S, Ibrahimi K, Chan KY, MaassenVanDenBrink A. Discovery techniques for calcitonin gene-related peptide receptor antagonists for potential antimigraine therapies. Expert Opin Drug Discov 2013; 8:1309-23. [DOI: 10.1517/17460441.2013.826644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Vermeersch SGG, Frederiks P, Maassen VandenBrink A, de Hoon J. Capsaicin-induced CGRP-mediated vasodilatation of the human skin: influence of gender, female hormones and migraine. J Headache Pain 2013. [PMCID: PMC3620129 DOI: 10.1186/1129-2377-14-s1-p124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Evaluation of a mobile NMR sensor for determining skin layers and locally estimating the T(2eff) relaxation time in the lower arm. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2012; 25:455-66. [PMID: 22581443 DOI: 10.1007/s10334-012-0317-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 04/14/2012] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
Abstract
OBJECT The nuclear magnetic resonance (NMR) mobile-universal-surface-explorer (MOUSE) was evaluated in a pilot study to determine its ability to detect physiological changes in human skin caused by physical or pharmacological interventions. MATERIALS AND METHODS The left lower arm skin thicknesses of ten male subjects were measured five times using a Profile NMR-MOUSE(®) ((1)H, 19 MHz) before and after a venous occlusion manoeuvre. In five of the subjects, the T(2eff) relaxation times were derived from a bi-exponential fitting and were determined in the dermis and subcutis before and after applying a salve containing capsaicin. RESULTS The dermis (including the epidermis) showed rather homogeneous signal amplitudes. The subcutis was characterised by higher and more variable amplitudes. The full-skin thickness values were affirmed by ultrasound imaging. The NMR profiles did not show significant skin swelling due to venous occlusion. In the dermis, capsaicin caused significant (p < 0.05) decreases in both components of T(2eff) (100 ± 19 ms-19 ± 10 ms; 9.5 ± 0.5 ms-7.2 ± 1.6 ms). In the subcutis, the T(2eff) was not affected. CONCLUSION In principle, NMR-MOUSE profiles are capable of detecting skin structure. However, precise measurements are jeopardised by poor reproducibility, long acquisition times, and incompatibility between the geometries of the sensitive area of the instrument and the non-planar structure of the skin. In the dermis, T(2eff) contrast could be used to detect the changes in tissue composition caused by inflammatory reactions.
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Potential mechanisms of prospective antimigraine drugs: A focus on vascular (side) effects. Pharmacol Ther 2011; 129:332-51. [DOI: 10.1016/j.pharmthera.2010.12.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 11/09/2010] [Indexed: 12/13/2022]
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Sinclair SR, Kane SA, Van der Schueren BJ, Xiao A, Willson KJ, Boyle J, de Lepeleire I, Xu Y, Hickey L, Denney WS, Li CC, Palcza J, Vanmolkot FHM, Depré M, Van Hecken A, Murphy MG, Ho TW, de Hoon JN. Inhibition of capsaicin-induced increase in dermal blood flow by the oral CGRP receptor antagonist, telcagepant (MK-0974). Br J Clin Pharmacol 2010; 69:15-22. [PMID: 20078608 DOI: 10.1111/j.1365-2125.2009.03543.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT * Calcitonin gene-related peptide (CGRP) was first described as a potent vasodilator. * CGRP is also increasingly recognized as a key player in the pathophysiology of migraine, and CGRP receptor antagonists potentially offer a new approach for treating migraine. * A novel pharmacodynamic assay to measure CGRP receptor antagonist activity non-invasively in humans has been developed, which involves measuring the increase in dermal blood flow induced by topical application of capsaicin on the forearm. WHAT THIS STUDY ADDS * This study shows that the novel oral CGRP receptor antagonist, telcagepant, inhibits the increases in dermal blood flow induced by the topical application of capsaicin on the human forearm. * This experimental medicine model may have utility to assist in dose selection for the development of CGRP receptor antagonists. AIMS To evaluate inhibition of capsaicin-induced increase in dermal blood flow (DBF) following telcagepant (MK-0974), a potent and selective orally bioavailable calcitonin gene-related peptide (CGRP) receptor antagonist being developed for the acute treatment of migraine. METHODS A three-period crossover study in 12 healthy adult men. Each subject received a single oral dose of telcagepant 300 mg, telcagepant 800 mg or placebo at 0 h, followed 0.5 and 3.5 h later by two topical doses of 300 and 1000 microg capsaicin per 20 microl water-ethanol mixture. Capsaicin was applied at two sites on the volar surface of the subjects' left and right forearms. DBF was assessed by laser Doppler perfusion imaging immediately before ('baseline'), and 0.5 h after each capsaicin application at 1 and 4 h. Plasma samples to determine telcagepant concentrations were collected immediately after laser Doppler perfusion imaging. A pharmacodynamic model was developed to explore the relationship between plasma concentration and inhibition of capsaicin-induced increase in DBF. RESULTS Geometric mean plasma concentrations after dosing with 300 mg and 800 mg telcagepant were 720 and 1146 nm, respectively, at 1 h, vs. 582 and 2548 nm, respectively, at 4 h. The pharmacodynamic model suggested that the EC(90) for telcagepant inhibition of capsaicin-induced increases in DBF was 909 nm. CONCLUSIONS Telcagepant inhibits the increases in DBF induced by the topical application of capsaicin on the human forearm. This experimental medicine model may have utility to assist in dose selection for the development of CGRP receptor antagonists.
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Cutaneous nociception and neurogenic inflammation evoked by PACAP38 and VIP. J Headache Pain 2010; 11:309-16. [PMID: 20454993 PMCID: PMC3476346 DOI: 10.1007/s10194-010-0214-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 04/06/2010] [Indexed: 12/21/2022] Open
Abstract
Pituitary adenylate cyclase-activating peptide-38 (PACAP38) and vasoactive intestinal peptide (VIP) belong to the same secretin–glucagon superfamily and are present in nerve fibers in dura and skin. Using a model of acute cutaneous pain we explored differences in pain perception and vasomotor responses between PACAP38 and VIP in 16 healthy volunteers in a double-blind, placebo-controlled, crossover study. All participants received intradermal injections of 200 pmol PACAP38, 200 pmol VIP and placebo into the volar forearm. Measurements included pain intensity on a visual analog scale (VAS), blood flow by laser Doppler flowmetry, visual flare and wheal. Pain intensities after PACAP38 and VIP were mild and limited to a short time of about 100 s after injection. The area under the VAS-time curve was larger following PACAP38 (P = 0.004) and VIP (P = 0.01) compared to placebo. We found no statistical difference in pain perception between PACAP38 and VIP. Skin blood flow increase, flare and wheal were larger after both PACAP38 (P = 0.011) and VIP (P = 0.001) compared to placebo. VIP induced a considerably larger increase in skin blood flow, flare and wheal than PACAP38 (P = 0.002). In conclusion, we found that peripheral nociceptive cutaneous responses elicited by PACAP38 and VIP are similar in healthy volunteers. This suggests that acute pain and vasomotor responses following intradermal injections of PACAP38 and VIP are primarily mediated by VPAC receptors.
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Møller AT, Bach FW, Feldt-Rasmussen U, Rasmussen AK, Hasholt L, Sommer C, Kølvraa S, Jensen TS. Autonomic skin responses in females with Fabry disease. J Peripher Nerv Syst 2010; 14:159-64. [PMID: 19909479 DOI: 10.1111/j.1529-8027.2009.00227.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Fabry disease is a genetic lysosomal disorder with dysfunction of the lysosomal enzyme alpha-galactosidase A causing accumulation of glycolipids in multiple organs including the nervous system and with neuropathy as a prominent manifestation. Neurological symptoms include pain and autonomic dysfunction. This study examined peripheral autonomic nerve function in 19 female patients with Fabry disease and 19 sex and age-matched controls by measuring (1) sweat production following acetylcholine challenge; (2) the sympathetically mediated vasoconstrictor responses to inspiratory gasp, stress, and the cold pressor test; and (3) cutaneous blood flow following capsaicin. The vasoconstrictor response to inspiratory gasp was increased in Fabry patients compared to controls (p = 0.03), while the response to cold and mental stress did not change. Female patients with Fabry disease had a reduced sweat response to iontophoresis of acetylcholine (p = 0.04) and a smaller capsaicin-induced flare compared to controls. These findings suggest that female patients both have an impaired C-fiber function and local abnormalities in blood vessels and sweat glands.
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Affiliation(s)
- Anette T Møller
- Danish Pain Research Center, University Hospital of Aarhus, Denmark.
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Williams TM, Burgey CS, Salvatore CA. Calcitonin gene-related peptide receptor antagonists for the treatment of migraine. PROGRESS IN MEDICINAL CHEMISTRY 2009; 47:1-35. [PMID: 19328288 DOI: 10.1016/s0079-6468(08)00201-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Theresa M Williams
- Department of Medicinal Chemistry, Merck Research Laboratories, West Point, PA 19486, USA
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Aronson JK, Cohen A, Lewis LD. Clinical pharmacology--providing tools and expertise for translational medicine. Br J Clin Pharmacol 2008; 65:154-7. [PMID: 18251756 DOI: 10.1111/j.1365-2125.2008.03101.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Van der Schueren BJ, Rogiers A, Vanmolkot FH, Van Hecken A, Depré M, Kane SA, De Lepeleire I, Sinclair SR, de Hoon JN. Calcitonin gene-related peptide8-37 antagonizes capsaicin-induced vasodilation in the skin: evaluation of a human in vivo pharmacodynamic model. J Pharmacol Exp Ther 2008; 325:248-55. [PMID: 18216286 DOI: 10.1124/jpet.107.133868] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to identify the mediators involved in capsaicin-induced vasodilation in the human skin and to evaluate a pharmacodynamic model for the early clinical evaluation of calcitonin gene-related peptide (CGRP) receptor antagonists. Dermal blood flow (DBF) response of the forearm skin to topically applied capsaicin was measured using laser Doppler perfusion imaging in 22 subjects. The effect of intra-arterially administered CGRP(8-37) (1200 ng . min(-1) . dl(-1) forearm), indomethacin (5 mug . min(-1) . dl(-1) forearm), and N(G)-monomethyl-l-arginine (l-NMMA; 0.2 mg . min(-1) dl(-1) forearm), and orally administered aprepitant (375 mg) on capsaicin-induced dermal vasodilation was assessed. Furthermore, the diurnal variation of the DBF response to capsaicin was studied. CGRP(8-37) inhibited the capsaicin-induced DBF increase: 217(145, 290)% in infused versus 370 (254, 486)% in the noninfused arm [mean (95% CI); p = 0.004]. In contrast, indomethacin, l-NMMA, aprepitant, and the time of assessment did not affect the DBF response to capsaicin. Thus, capsaicin-induced vasodilation in the human forearm skin is largely mediated by CGRP, but not by vasodilating prostaglandins, nitric oxide, or substance P. The response to capsaicin does not display a circadian rhythm. A pharmacodynamic model is proposed to evaluate CGRP receptor antagonists in humans in vivo.
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Affiliation(s)
- B J Van der Schueren
- Center for Clinical Pharmacology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium.
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