Kallikrein-like esterase and peptidase activities in CSF during migraine attacks and free intervals

Cerebrospinal fluid biomarkers in primary headache disorders

OBJECTIVE

The object of this review is to examine the published literature for cerebrospinal fluid laboratory measures of primary headache disorders to identify biomarkers and provide recommendations for future biomarker discovery.

BACKGROUND

Biomarkers may distinguish deviation from a normal state, provide insight into mechanisms of pathophysiology, quantify the degree of change, discriminate what may be clinically overlapping disorders, and allow monitoring and/or selection of specific treatment. High-throughput, discovery technologies fuel the ability to reveal more biomarkers than past hypothesis-driven studies. DESIGN OR METHODS: Publications were identified in PubMed, ISI web of knowledge (both Web of Science and BIOSYS), and SciFinder, using the key words for cerebrospinal fluid (CSF) and migraine, headache, or biomarkers. Additional references were sought from the papers identified in these searches. Data were assessed relating to all primary headache types for clinical and scientific methods and results.

RESULTS

Fifty-five out of 82 biomarkers were found from 55 publications, though none have been validated for clinical utility. Data for site (ventricular, cervical, lumbar) and timing of CSF collection, headache state, and diagnostic description were patchy, and controls were often poorly defined. Most routinely performed CSF measurements were within normal limits. Most levels of pain-related molecules were reduced, and concentrations of most neurotransmitters, neuropeptides, proteins, and small molecules were increased. Though few studies assessed the specificity of biomarkers for primary headaches, it is clear that there are differences in CSF biomarkers between migraine, cluster headache, tension-type headache, and trigeminal neuralgia.

CONCLUSIONS

The high proportion (67%) of biomarkers identified from laboratory measures tested thus far predicts that many more biomarkers will be identified for primary headaches when more candidates are evaluated. In order to discover and evaluate more biomarkers, especially those that may have clinical application for headache management, 3 recommendations are encouraged: prospective design of care-independent studies; evaluation of more clinical variables; and evaluation of substantially more candidates by using discovery-based research methods. Outlines of approaches to pursue these aims are proposed.

Histamine release from leucocytes during migraine attack

Spontaneous histamine release (SHR) from leucocytes (basophils) of 27 migraine patients was investigated during various phases of attack. Mean SHR during the first 3 h of attack (33.7%) was increased compared with the mean SHR from leucocytes of healthy persons (15.9%), but differed insignificantly from the mean SHR in symptom-free periods. Histamine release (HR) from leucocytes of healthy persons suspended in migraine sera from different time-periods of attack was also increased compared with HR in control sera, i.e. high HR could be induced by passive transfer of serum. But the mean HRs in sera from different time-periods of attack were insignificantly different from the mean HR in sera from symptom-free periods. The increased SHR may contribute to vascular hyperreactivity in migraine.

Arginine esterase in cerebrospinal fluid and pro-arginine esterase in plasma from patients with migraine

Estimates of prekallikrein levels in plasma specimens from patients with migraine and from healthy individuals were obtained by determining the benzoyl-arginine ethyl ester (BAEe) esterase activities developed on activation with kaolin, as suggested by Costerase level- 'n the patients and in the control material, and kinetic data provided no evidence of a difference in inhibitor levels. Only very low BAEe esterase activity was registered in samples of cerebrospinal fluid obtained from the patients and no significant difference between attacks and free intervals was detected. When citrated EDTA-treated plasma was activated with acetone-incubated normal plasma containing prekallikrein activator (factor XIIf), no significant difference in BAEe esterase activity was noticed between plasma from the patients and that from the control persons. When, however, citrated plasma without EDTA was used, a significantly higher peak level of esterase activity was registered in the patient plasma. This observation might suggest the presence of a factor positioned between active factor XII and prekallikrein, and present in higher amounts in plasma from patients with migraine than in healthy individuals.

The role of humoral mediators in migraine headache

The classical vascular mechanism of migraine attacks demonstrated by Wolff — intracranial vasoconstriction during the prodromal stage and passive vasodilatation of extracranial arteries during the painful phase — has been confirmed by modern methods. Arterial distension is, however, not sufficient to explain the origin of the pain: to give rise to an acute migraineous pain, it must be associated with a lowered pain threshold of the receptors situated in the wall of the affected vessels. A number of humoral factors — plasmakinin, serotonin, histamine — intervene in the chain of events that culminates in migraine headache.

At the start of the attack, the blood platelets release serotonin, the mast cells in the affected area release histamine and proteolytic enzymes that split plasmakininogens to form plas-makinins. Free serotonin and histamine increase capillary permeability and favor transudation of plasmakinin into the vessel walls andperivascular tissues. The combined effect of serotonin and plasmakinin on the vessel wall receptors reduces their pain threshold. On the other hand, the bulk of the released serotonin is excreted as 5-HIAA, and plasma serotonin falls. Since serotonin has a constricting effect on the extracranial arteries and a dilating one on the capillaries, the fall in its plasma level induces hypotonia of these arteries and capillary constriction, which results in a passive distension of the arterial walls. The two factors necessary for the production of pain are thus present: a low pain threshold and vascular distension. In addition to these three main humoral mediators, the part played by tyramine in migraine of alimentary origin, the precipitating effect of estrogen decrease in mentrual migraine and the hypothetical role of prostaglan-dins and prolactin are discussed.