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Tasma Z, Rees TA, Guo S, Tan S, O'Carroll SJ, Faull RLM, Curtis MA, Christensen SL, Hay DL, Walker CS. Pharmacology of PACAP and VIP receptors in the spinal cord highlights the importance of the PAC 1 receptor. Br J Pharmacol 2024. [PMID: 38616050 DOI: 10.1111/bph.16376] [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: 12/06/2022] [Revised: 12/18/2023] [Accepted: 01/20/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND AND PURPOSE The spinal cord is a key structure involved in the transmission and modulation of pain. Pituitary adenylate cyclase-activating peptide (PACAP) and vasoactive intestinal peptide (VIP), are expressed in the spinal cord. These peptides activate G protein-coupled receptors (PAC1, VPAC1 and VPAC2) that could provide targets for the development of novel pain treatments. However, it is not clear which of these receptors are expressed within the spinal cord and how these receptors signal. EXPERIMENTAL APPROACH Dissociated rat spinal cord cultures were used to examine agonist and antagonist receptor pharmacology. Signalling profiles were determined for five signalling pathways. The expression of different PACAP and VIP receptors was then investigated in mouse, rat and human spinal cords using immunoblotting and immunofluorescence. KEY RESULTS PACAP, but not VIP, potently stimulated cAMP, IP1 accumulation and ERK and cAMP response element-binding protein (CREB) but not Akt phosphorylation in spinal cord cultures. Signalling was antagonised by M65 and PACAP6-38. PACAP-27 was more effectively antagonised than either PACAP-38 or VIP. The patterns of PAC1 and VPAC2 receptor-like immunoreactivity appeared to be distinct in the spinal cord. CONCLUSIONS AND IMPLICATIONS The pharmacological profile in the spinal cord suggested that a PAC1 receptor is the major functional receptor subtype present and thus likely mediates the nociceptive effects of the PACAP family of peptides in the spinal cord. However, the potential expression of both PAC1 and VPAC2 receptors in the spinal cord highlights that these receptors may play differential roles and are both possible therapeutic targets.
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Affiliation(s)
- Zoe Tasma
- School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| | - Tayla A Rees
- School of Biological Sciences, The University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, Auckland, New Zealand
| | - Song Guo
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Odontology, Panum Institute, Faculty of Health, University of Copenhagen, Copenhagen, Denmark
| | - Sheryl Tan
- Department of Anatomy and Medical Imaging and Centre for Brain Research, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Simon J O'Carroll
- Department of Anatomy and Medical Imaging and Centre for Brain Research, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Richard L M Faull
- Department of Anatomy and Medical Imaging and Centre for Brain Research, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Maurice A Curtis
- Department of Anatomy and Medical Imaging and Centre for Brain Research, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Sarah L Christensen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Debbie L Hay
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, Auckland, New Zealand
- Department of Pharmacology and Toxicology, The University of Otago, Dunedin, New Zealand
| | - Christopher S Walker
- School of Biological Sciences, The University of Auckland, Auckland, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, Auckland, New Zealand
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Benedicter N, Vogler B, Kuhn A, Schramm J, Mackenzie KD, Stratton J, Dux M, Messlinger K. Glycerol Trinitrate Acts Downstream of Calcitonin Gene-Related Peptide in Trigeminal Nociception-Evidence from Rodent Experiments with Anti-CGRP Antibody Fremanezumab. Cells 2024; 13:572. [PMID: 38607011 PMCID: PMC11011795 DOI: 10.3390/cells13070572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/13/2024] Open
Abstract
Calcitonin gene-related peptide (CGRP) and nitric oxide (NO) have been recognized as important mediators in migraine but their mechanisms of action and interaction have not been fully elucidated. Monoclonal anti-CGRP antibodies like fremanezumab are successful preventives of frequent migraine and can be used to study CGRP actions in preclinical experiments. Fremanezumab (30 mg/kg) or an isotype control monoclonal antibody was subcutaneously injected to Wistar rats of both sexes. One to several days later, glyceroltrinitrate (GTN, 5 mg/kg) mimicking nitric oxide (NO) was intraperitoneally injected, either once or for three consecutive days. The trigeminal ganglia were removed to determine the concentration of CGRP using an enzyme-linked immunosorbent assay (ELISA). In one series of experiments, the animals were trained to reach an attractive sugar solution, the access to which could be limited by mechanical or thermal barriers. Using a semi-automated registration system, the frequency of approaches to the source, the residence time at the source, and the consumed solution were registered. The results were compared with previous data of rats not treated with GTN. The CGRP concentration in the trigeminal ganglia was generally higher in male rats and tended to be increased in animals treated once with GTN, whereas the CGRP concentration decreased after repetitive GTN treatment. No significant difference in CGRP concentration was observed between animals having received fremanezumab or the control antibody. Animals treated with GTN generally spent less time at the source and consumed less sugar solution. Without barriers, there was no significant difference between animals having received fremanezumab or the control antibody. Under mechanical barrier conditions, all behavioral parameters tended to be reduced but animals that had received fremanezumab tended to be more active, partly compensating for the depressive effect of GTN. In conclusion, GTN treatment seems to increase the production of CGRP in the trigeminal ganglion independently of the antibodies applied, but repetitive GTN administration may deplete CGRP stores. GTN treatment generally tends to suppress the animals' activity and increase facial sensitivity, which is partly compensated by fremanezumab through reduced CGRP signaling. If CGRP and NO signaling share the same pathway in sensitizing trigeminal afferents, GTN and NO may act downstream of CGRP to increase facial sensitivity.
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Affiliation(s)
- Nicola Benedicter
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-University, D-91054 Erlangen, Germany; (N.B.)
| | - Birgit Vogler
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-University, D-91054 Erlangen, Germany; (N.B.)
| | - Annette Kuhn
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-University, D-91054 Erlangen, Germany; (N.B.)
| | - Jana Schramm
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-University, D-91054 Erlangen, Germany; (N.B.)
| | | | | | - Mária Dux
- Department of Physiology, University of Szeged, H-6720 Szeged, Hungary;
| | - Karl Messlinger
- Institute of Physiology and Pathophysiology, Friedrich-Alexander-University, D-91054 Erlangen, Germany; (N.B.)
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Rossignol J, Ouimet T, Poras H, Dallel R, Luccarini P. Synergistic effect of combining dual enkephalinase inhibitor PL37 and sumatriptan in a preclinical model of migraine. Headache 2024; 64:243-252. [PMID: 38385629 DOI: 10.1111/head.14681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE The aim of this study was to test whether a combination of sumatriptan with dual enkephalinase inhibitor PL37 would result in an additive or a synergistic effect. BACKGROUND Combination treatment is frequently used to improve the therapeutic efficacy of drugs. The co-administration of two drugs may result in efficacy at lower doses than those needed for either drug alone, thus minimizing side effects. Here, we tested the effect of the co-administration of two drugs on cutaneous mechanical hypersensitivity (MH), a symptom often affecting cephalic regions in patients with migraine: dual enkephalinase inhibitor PL37, a small molecule that protects enkephalins from rapid degradation, and sumatriptan, a serotonin 5-HT1B/1D receptor agonist. METHODS We investigated the effects of oral administrations of sumatriptan, PL37, or their combination on changes in cutaneous mechanical sensitivity induced by a single intraperitoneal administration of the nitric oxide donor, isosorbide dinitrate (ISDN) in male rats. Mechanical sensitivity was assessed using von Frey filaments applied to the face of animals to determine pain thresholds. Isobolographic analysis was performed to determine the nature of the interaction between sumatriptan and PL37. RESULTS Sumatriptan as well as PL37 each produced a dose-dependent inhibition of ISDN-induced cephalic MH. Median effective dose (ED50 ) values were 0.3 and 1.1 mg/kg for sumatriptan and PL37, respectively. An isobolographic analysis of the effect of combined doses of sumatriptan and PL37 based on their calculated ED50 values demonstrated a synergistic effect of the combination on cephalic MH, with an interaction index of 0.14 ± 0.04. CONCLUSION These results suggest that PL37 acts synergistically with sumatriptan to produce an anti-allodynic effect in a rat model of migraine. Thus, combining PL37 and sumatriptan may be a useful therapeutic strategy in the management of migraine. PLAIN LANGUAGE SUMMARY There have been many advances in migraine treatment, but we still need more options that are effective and have few side effects. Sumatriptan is one available drug for acute treatment of migraine, but it does not work for every patient and is not suitable for some people. We tested a new drug called PL37 (that blocks enkephalinases) together with sumatriptan and the combination minimized side effects and allowed lower doses of the drugs for effective migraine treatment in an animal model.
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Affiliation(s)
- Jeanne Rossignol
- Neuro-Dol, Inserm, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
- R & D Department, Pharmaleads SA, Paris, France
| | | | - Hervé Poras
- R & D Department, Pharmaleads SA, Paris, France
| | - Radhouane Dallel
- Neuro-Dol, Inserm, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Philippe Luccarini
- Neuro-Dol, Inserm, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
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4
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Zhang Y, Huang W, Shan Z, Zhou Y, Qiu T, Hu L, Yang L, Wang Y, Xiao Z. A new experimental rat model of nocebo-related nausea involving double mechanisms of observational learning and conditioning. CNS Neurosci Ther 2024; 30:e14389. [PMID: 37545429 PMCID: PMC10848046 DOI: 10.1111/cns.14389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/12/2023] [Accepted: 07/23/2023] [Indexed: 08/08/2023] Open
Abstract
AIM The nocebo effect, such as nausea and vomiting, is one of the major reasons patients discontinue therapy. The underlying mechanisms remain unknown due to a lack of reliable experimental models. The goal of this study was to develop a new animal model of nocebo-related nausea by combining observational learning and Pavlovian conditioning paradigms. METHODS Male Sprague-Dawley rats with nitroglycerin-induced migraine were given 0.9% saline (a placebo) or LiCl (a nausea inducer) following headache relief, according to different paradigms. RESULTS Both strategies provoked nocebo nausea responses, with the conditioning paradigm having a greater induction impact. The superposition of two mechanisms led to a further increase in nausea responses. A preliminary investigation of the underlying mechanism revealed clearly raised peripheral and central cholecystokinin (CCK) levels, as well as specific changes in the 5-hydroxytryptamine and cannabinoid systems. Brain networks related to emotion, cognition, and visceral sense expressed higher c-Fos-positive neurons, including the anterior cingulate cortex (ACC), insula, basolateral amygdala (BLA), thalamic paraventricular nucleus (PVT), hypothalamic paraventricular nucleus (PVN), nucleus tractus solitarius (NTS), periaqueductal gray (PAG), and dorsal raphe nucleus-dorsal part (DRD). We also found that nausea expectances in the model could last for at least 12 days. CONCLUSION The present study provides a useful experimental model of nocebo nausea that might be used to develop potential molecular pathways and therapeutic strategies for nocebo.
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Affiliation(s)
- Yu Zhang
- Department of NeurologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
- Central LaboratoryRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Wanbin Huang
- Department of NeurologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
- Central LaboratoryRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Zhengming Shan
- Department of NeurologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
- Central LaboratoryRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Yanjie Zhou
- Department of NeurologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
- Central LaboratoryRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Tao Qiu
- Department of NeurologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Luyu Hu
- Department of NeurologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Liu Yang
- Department of NeurologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Yue Wang
- Department of NeurologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
| | - Zheman Xiao
- Department of NeurologyRenmin Hospital of Wuhan UniversityWuhanHubei ProvinceChina
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5
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de Boer I, Verhagen IE, Souza MNP, Ashina M. Place of next generation acute migraine specific treatments among triptans, non-responders and contraindications to triptans and possible combination therapies. Cephalalgia 2023; 43:3331024221143773. [PMID: 36739516 DOI: 10.1177/03331024221143773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: For many years triptans have been the cornerstone of acute migraine treatment. Nevertheless, treatment with triptans may not always be initiated due to contraindications (seen in approximately one fifth of patients) or inadequate response (seen in approximately one third of patients). New acute therapies, including 5-hydroxytryptamine (5-HT)1F receptor agonists, also known as ditans (lasmiditan) and small molecule antagonists of the calcitonin gene-related peptide receptor, also known as gepants (rimegepant and ubrogepant), may be an effective alternative. Methods: We searched Pubmed for keywords, summarized the literature and provided a comprehensive review on the place of next generation acute migraine specific treatments among triptans. Results and conclusion: Post-hoc analyses reported no differences in efficacy of gepants/ditans between responders and non-responders to triptans, but research is hampered by lack of consensus on the definition of non-responder. Due to (partially) overlapping mechanisms of action, it remains unknown whether combination therapy with lasmiditan, gepants and triptans will have added value over monotherapy. Preclinical studies and post-hoc analyses cautiously indicate that these new drugs are safe for patients with cardiovascular risk factors. However, long-term studies are needed to prove cardiovascular safety. The risk of developing medication overuse headache may differ between triptans, ditans and gepants, but further studies are needed to confirm this difference. Head-to-head randomized controlled trials of acute therapies and combinations of therapies are needed to determine their place in migraine treatment among established therapies.
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Affiliation(s)
- Irene de Boer
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | - Iris Elsa Verhagen
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Messoud Ashina
- Department of Neurology, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Denmark
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Yu Z, Li B, Tang W, Dong Z, Liu R, Yu S. Acute sleep deprivation aggravates nitroglycerin-evoked hyperalgesia in mice. Mol Pain 2023; 19:17448069221149645. [PMID: 36550614 PMCID: PMC9830572 DOI: 10.1177/17448069221149645] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Sleep deprivation can trigger migraine, and migraineurs often choose to sleep to relieve headaches during acute migraine. This study aimed to explore the effect of acute sleep deprivation on hyperalgesia induced by nitroglycerin in mice. In part one, after either 6-h sleep deprivation or 6-h normal sleep, mice were intraperitoneally injected with nitroglycerin or saline. The mechanical pain threshold and withdrawal latency of the hindpaw were measured every 30 min for 6 h. Next, the same sleep deprivation and injection procedure was performed with new mice, and mice were sacrificed 4.5 h after injection. The trigeminal nucleus caudalis and upper cervical spinal segments were taken for immunofluorescence Fos staining. In part two, after injection of saline or nitroglycerin, the mice were either deprived of sleep for 6 h or allowed to sleep without interference. The mechanical and thermal pain threshold were measured after 6 h. In part three, we compared the sleep time of mice after intraperitoneal injection of saline or nitroglycerin without interference. Sleep deprivation for 6 h did not cause any changes in the baseline pain thresholds in mice. However, pretreatment with 6-h sleep deprivation significantly prolonged the duration of hyperalgesia induced by nitroglycerin. Additionally, the expression of Fos at 4.5 h was significantly higher in the 6-h sleep deprivation and nitroglycerin group than in the other three groups. When intraperitoneal injection was given first, the mechanical pain threshold of the hind paw was significantly lower in the group that received nitroglycerin with 6-h sleep deprivation than in the other groups. Compared to the saline injection, one-time nitroglycerin injection would result in a significant increase in sleep latency and decrease in sleep duration for the normal mice. Acute sleep deprivation significantly aggravated the hyperalgesia induced by nitroglycerin in mice, which highlights the importance of sleep disorders for migraine.
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Affiliation(s)
- Zhe Yu
- International Headache Center, Department of Neurology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Bozhi Li
- International Headache Center, Department of Neurology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Wenjing Tang
- International Headache Center, Department of Neurology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Zhao Dong
- International Headache Center, Department of Neurology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Ruozhuo Liu
- International Headache Center, Department of Neurology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Shengyuan Yu
- International Headache Center, Department of Neurology, the First Medical Centre, Chinese PLA General Hospital, Beijing, China,Shengyuan Yu, Department of Neurology, the First Medical Centre, Chinese PLA General Hospital, 28th Fuxing Road, Haidian District, Beijing, China
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7
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Guo S, Ernstsen C, Hay-Schmidt A, Ashina M, Olesen J, Christensen SL. PACAP signaling is not involved in GTN- and levcromakalim-induced hypersensitivity in mouse models of migraine. J Headache Pain 2022; 23:155. [PMID: 36471250 PMCID: PMC9724374 DOI: 10.1186/s10194-022-01523-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/04/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND Calcitonin gene-related peptide (CGRP) antagonizing drugs represents the most important advance in migraine therapy for decades. However, these new drugs are only effective in 50-60% of patients. Recent studies have shown that the pituitary adenylate cyclase-activating peptide (PACAP38) pathway is independent from the CGRP signaling pathway. Here, we investigate PACAP38 signaling pathways in relation to glyceryl trinitrate (GTN), levcromakalim and sumatriptan. METHODS In vivo mouse models of PACAP38-, GTN-, and levcromakalim-induced migraine were applied using tactile sensitivity to von Frey filaments as measuring readout. Signaling pathways involved in the three models were dissected using PACAP-inhibiting antibodies (mAbs) and sumatriptan. RESULTS We showed that PACAP mAbs block PACAP38 induced hypersensitivity, but not via signaling pathways involved in GTN and levcromakalim. Also, sumatriptan has no effect on PACAP38-induced hypersensitivity relevant to migraine. This is the first study testing the effect of a PACAP-inhibiting drug on GTN- and levcromakalim-induced hypersensitivity. CONCLUSIONS Based on the findings in our mouse model of migraine using migraine-inducing compounds and anti-migraine drugs, we suggest that PACAP acts via a distinct pathway. Using PACAP38 antagonism may be a novel therapeutic target of interest in a subgroup of migraine patients who do not respond to existing therapies.
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Affiliation(s)
- Song Guo
- grid.475435.4Department of Neurology, Danish Headache Center, Research Institute, Copenhagen University Hospital-Rigshospitalet Glostrup, Nordstjernevej 42, Glostrup 2600 Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Odontology, Faculty of Health, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Ernstsen
- grid.475435.4Department of Neurology, Danish Headache Center, Research Institute, Copenhagen University Hospital-Rigshospitalet Glostrup, Nordstjernevej 42, Glostrup 2600 Copenhagen, Denmark
| | - Anders Hay-Schmidt
- grid.5254.60000 0001 0674 042XDepartment of Odontology, Faculty of Health, Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Messoud Ashina
- grid.475435.4Department of Neurology, Danish Headache Center, Human Migraine Research Unit, Copenhagen University Hospital Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Jes Olesen
- grid.475435.4Department of Neurology, Danish Headache Center, Research Institute, Copenhagen University Hospital-Rigshospitalet Glostrup, Nordstjernevej 42, Glostrup 2600 Copenhagen, Denmark
| | - Sarah Louise Christensen
- grid.475435.4Department of Neurology, Danish Headache Center, Research Institute, Copenhagen University Hospital-Rigshospitalet Glostrup, Nordstjernevej 42, Glostrup 2600 Copenhagen, Denmark
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8
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Antagonism of CGRP Receptor: Central and Peripheral Mechanisms and Mediators in an Animal Model of Chronic Migraine. Cells 2022; 11:cells11193092. [PMID: 36231054 PMCID: PMC9562879 DOI: 10.3390/cells11193092] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022] Open
Abstract
Calcitonin-gene-related peptide (CGRP) plays a key role in migraine pathophysiology and more specifically in the mechanisms underlying peripheral and central sensitization. Here, we explored the interaction of CGRP with other pain mediators relevant for neuronal sensitization in an animal model of chronic migraine. Male Sprague-Dawley rats were exposed to nitroglycerin (NTG, 5 mg/kg, i.p.) or vehicle co-administered with the CGRP receptor antagonist olcegepant (2 mg/kg i.p.), or its vehicle, every other day over a 9-day period. Twenty-four hours after the last injection of NTG (or vehicle), behavioral test and ex vivo analysis were performed. Olcegepant attenuated NTG-induced trigeminal hyperalgesia in the second phase of the orofacial formalin test. Interestingly, it also reduced gene expression and protein levels of CGRP, pro-inflammatory cytokines, inflammatory-associated miRNAs (miR-155-5p, miR-382-5p, and miR-34a-5p), and transient receptor potential ankyrin channels in the medulla-pons area, cervical spinal cord, and trigeminal ganglia. Similarly, olcegepant reduced the NTG-induced increase in CGRP and inflammatory cytokines in serum. The findings show that the activation of the CGRP pathway in a migraine animal model was associated to the persistent activation of inflammatory pathways, which was paralleled by a condition of hyperalgesia. These molecular events are relevant for informing us about the mechanisms underlying chronic migraine.
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Benbow T, Teja F, Sheikhi A, Exposto FG, Svensson P, Cairns BE. Peripheral N-methyl-D-aspartate receptor activation contributes to monosodium glutamate-induced headache but not nausea behaviours in rats. Sci Rep 2022; 12:13894. [PMID: 35974090 PMCID: PMC9381496 DOI: 10.1038/s41598-022-18290-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/09/2022] [Indexed: 12/29/2022] Open
Abstract
Monosodium glutamate induces behaviors thought to reflect headache and nausea in rats. We explored the effects of the N-methyl-d-aspartate receptor antagonist (2R)-amino-5-phosphonovaleric acid, the inotropic glutamate receptor antagonist kynurenic acid, and the CGRP receptor antagonist olcegepant, on monosodium glutamate-induced increases in nocifensive, headache-like and nausea behaviours. Effects of these antagonists on motor function were examined with a rotarod. The effect of the dopamine receptor antagonist metoclopramide and the serotonin 3 receptor antagonist ondansetron on nausea behaviour was also assessed. (2R)-amino-5-phosphonovaleric acid, and to a lesser extent, kynurenic acid and olcegepant, reduced nocifensive and headache-like behaviours evoked by monosodium glutamate. No alteration in motor function by (2R)-amino-5-phosphonovaleric acid, kynurenic acid or olcegepant was observed. No sex-related differences in the effectiveness of these agents were identified. Nausea behaviour was significantly more pronounced in male than in female rats. Olcegepant, ondansetron and metoclopramide ameliorated this nausea behaviour in male rats. Ondansetron and metoclopramide also reduced headache-like behaviour in male rats. These findings suggest that peripheral N-methyl-d-aspartate receptor activation underlies monosodium glutamate-induced headache-like behaviour but does not mediate the nausea behaviour in rats.
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Affiliation(s)
- Tarique Benbow
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, V6T 1Z3, Canada
| | - Felisha Teja
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, V6T 1Z3, Canada
| | - Afrooz Sheikhi
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, V6T 1Z3, Canada
| | - Fernando G Exposto
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus C, Denmark
| | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Boulevard 9, 8000, Aarhus C, Denmark
| | - Brian E Cairns
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, V6T 1Z3, Canada.
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10
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Calandre EP, Slim M, Rico-Villademoros F. How does a physician decide which pharmacotherapeutic option to select for acute migraine attacks? Expert Opin Pharmacother 2022; 23:1129-1133. [PMID: 35382662 DOI: 10.1080/14656566.2022.2060740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Elena P Calandre
- Instituto de Neurociencias, Universidad de Granada, Armilla, Spain
| | - Mahmoud Slim
- Instituto de Neurociencias, Universidad de Granada, Armilla, Spain
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Strassman AM, Melo-Carrillo A, Houle TT, Adams A, Brin MF, Burstein R. Atogepant - an orally-administered CGRP antagonist - attenuates activation of meningeal nociceptors by CSD. Cephalalgia 2022; 42:933-943. [PMID: 35332801 DOI: 10.1177/03331024221083544] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND This study investigated the mechanism of action of atogepant, a small-molecule CGRP receptor antagonist recently approved for the preventive treatment of episodic migraine, by assessing its effect on activation of mechanosensitive C- and Aδ-meningeal nociceptors following cortical spreading depression. METHODS Single-unit recordings of trigeminal ganglion neurons (32 Aδ and 20 C-fibers) innervating the dura was used to document effects of orally administered atogepant (5 mg/kg) or vehicle on cortical spreading depression-induced activation in anesthetized male rats. RESULTS Bayesian analysis of time effects found that atogepant did not completely prevent the activation of nociceptors at the tested dose, but it significantly reduced response amplitude and probability of response in both the C- and the Aδ-fibers at different time intervals following cortical spreading depression induction. For C-fibers, the reduction in responses was significant in the early phase (first hour), but not delayed phase of activation, whereas in Aδ-fibers, significant reduction in activation was apparent in the delayed phase (second and third hours) but not early phase of activation. CONCLUSIONS These findings identify differences between the actions of atogepant, a small molecule CGRP antagonist (partially inhibiting both Aδ and C-fibers) and those found previously for fremanezumab, a CGRP-targeted antibody (inhibiting Aδ fibers only) and onabotulinumtoxinA (inhibiting C-fibers only)- suggesting that these agents differ in their mechanisms for the preventive treatment of migraine.
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Affiliation(s)
- Andrew M Strassman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center.,Harvard Medical School, Boston, Massachusetts, USA
| | - Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center.,Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, USA
| | - Aubrey Adams
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, USA
| | - Mitchell F Brin
- Allergan, an AbbVie Company, Irvine, CA, USA.,Dept of Neurology, University of California, Irvine, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center.,Harvard Medical School, Boston, Massachusetts, USA
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Abstract
We aimed to investigate a sexually dimorphic role of calcitonin gene-related peptide (CGRP) in rodent models of pain. Based on findings in migraine where CGRP has a preferential pain-promoting effect in female rodents, we hypothesized that CGRP antagonists and antibodies would attenuate pain sensitization more efficaciously in female than male mice and rats. In hyperalgesic priming induced by activation of interleukin 6 signaling, CGRP receptor antagonists olcegepant and CGRP8-37 both given intrathecally, blocked, and reversed hyperalgesic priming only in females. A monoclonal antibody against CGRP, given systemically, blocked priming specifically in female rodents but failed to reverse it. In the spared nerve injury model, there was a transient effect of both CGRP antagonists, given intrathecally, on mechanical hypersensitivity in female mice only. Consistent with these findings, intrathecally applied CGRP caused a long-lasting, dose-dependent mechanical hypersensitivity in female mice but more transient effects in males. This CGRP-induced mechanical hypersensitivity was reversed by olcegepant and the KCC2 enhancer CLP257, suggesting a role for anionic plasticity in the dorsal horn in the pain-promoting effects of CGRP in females. In spinal dorsal horn slices, CGRP shifted GABAA reversal potentials to significantly more positive values, but, again, only in female mice. Therefore, CGRP may regulate KCC2 expression and/or activity downstream of CGRP receptors specifically in females. However, KCC2 hypofunction promotes mechanical pain hypersensitivity in both sexes because CLP257 alleviated hyperalgesic priming in male and female mice. We conclude that CGRP promotes pain plasticity in female rodents but has a limited impact in males.SIGNIFICANCE STATEMENT The majority of patients impacted by chronic pain are women. Mechanistic studies in rodents are creating a clear picture that molecular events promoting chronic pain are different in male and female animals. We sought to build on evidence showing that CGRP is a more potent and efficacious promoter of headache in female than in male rodents. To test this, we used hyperalgesic priming and the spared nerve injury neuropathic pain models in mice. Our findings show a clear sex dimorphism wherein CGRP promotes pain in female but not male mice, likely via a centrally mediated mechanism of action. Our work suggests that CGRP receptor antagonists could be tested for efficacy in women for a broader variety of pain conditions.
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OUP accepted manuscript. Brain 2022; 145:2450-2460. [DOI: 10.1093/brain/awac040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 12/07/2021] [Accepted: 01/09/2021] [Indexed: 11/14/2022] Open
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