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González-Hernández A, Marichal-Cancino BA, MaassenVanDenBrink A, Villalón CM. Side effects associated with current and prospective antimigraine pharmacotherapies. Expert Opin Drug Metab Toxicol 2018; 14:25-41. [PMID: 29226741 DOI: 10.1080/17425255.2018.1416097] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Migraine is a neurovascular disorder. Current acute specific antimigraine pharmacotherapies target trigeminovascular 5-HT1B/1D, 5-HT1F and CGRP receptors but, unfortunately, they induce some cardiovascular and central side effects that lead to poor treatment adherence/compliance. Therefore, new antimigraine drugs are being explored. Areas covered: This review considers the adverse (or potential) side effects produced by current and prospective antimigraine drugs, including medication overuse headache (MOH) produced by ergots and triptans, the side effects observed in clinical trials for the new gepants and CGRP antibodies, and a section discussing the potential effects resulting from disruption of the cardiovascular CGRPergic neurotransmission. Expert opinion: The last decades have witnessed remarkable developments in antimigraine therapy, which includes acute (e.g. triptans) and prophylactic (e.g. β-adrenoceptor blockers) antimigraine drugs. Indeed, the triptans represent a considerable advance, but their side effects (including nausea, dizziness and coronary vasoconstriction) preclude some patients from using triptans. This has led to the development of the ditans (5-HT1F receptor agonists), the gepants (CGRP receptor antagonists) and the monoclonal antibodies against CGRP or its receptor. The latter drugs represent a new hope in the antimigraine armamentarium, but as CGRP plays a role in cardiovascular homeostasis, the potential for adverse cardiovascular side effects remains latent.
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Affiliation(s)
| | - Bruno A Marichal-Cancino
- b Departamento de Fisiología y Farmacología, Universidad Autónoma de Aguascalientes , Ciudad Universitaria , Aguascalientes , México
| | - Antoinette MaassenVanDenBrink
- c Division of Vascular Medicine and Pharmacology, Department of Internal Medicine , Erasmus University Medical Center , Rotterdam , The Netherlands
| | - Carlos M Villalón
- d Departamento de Farmacobiología , Cinvestav-Coapa , Ciudad de México , México
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González-Hernández A, Marichal-Cancino BA, Lozano-Cuenca J, López-Canales JS, Muñoz-Islas E, Ramírez-Rosas MB, Villalón CM. Heteroreceptors Modulating CGRP Release at Neurovascular Junction: Potential Therapeutic Implications on Some Vascular-Related Diseases. Biomed Res Int 2016; 2016:2056786. [PMID: 28116293 DOI: 10.1155/2016/2056786] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 11/12/2016] [Accepted: 11/27/2016] [Indexed: 01/23/2023]
Abstract
Calcitonin gene-related peptide (CGRP) is a 37-amino-acid neuropeptide belonging to the calcitonin gene peptide superfamily. CGRP is a potent vasodilator with potential therapeutic usefulness for treating vascular-related disease. This peptide is primarily located on C- and Aδ-fibers, which have extensive perivascular presence and a dual sensory-efferent function. Although CGRP has two major isoforms (α-CGRP and β-CGRP), the α-CGRP is the isoform related to vascular actions. Release of CGRP from afferent perivascular nerve terminals has been shown to result in vasodilatation, an effect mediated by at least one receptor (the CGRP receptor). This receptor is an atypical G-protein coupled receptor (GPCR) composed of three functional proteins: (i) the calcitonin receptor-like receptor (CRLR; a seven-transmembrane protein), (ii) the activity-modifying protein type 1 (RAMP1), and (iii) a receptor component protein (RCP). Although under physiological conditions, CGRP seems not to play an important role in vascular tone regulation, this peptide has been strongly related as a key player in migraine and other vascular-related disorders (e.g., hypertension and preeclampsia). The present review aims at providing an overview on the role of sensory fibers and CGRP release on the modulation of vascular tone.
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Rice FL, Albrecht PJ, Wymer JP, Black JA, Merkies IS, Faber CG, Waxman SG. Sodium channel Nav1.7 in vascular myocytes, endothelium, and innervating axons in human skin. Mol Pain 2015; 11:26. [PMID: 25957174 PMCID: PMC4447014 DOI: 10.1186/s12990-015-0024-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/24/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The skin is a morphologically complex organ that serves multiple complementary functions, including an important role in thermoregulation, which is mediated by a rich vasculature that is innervated by sympathetic and sensory endings. Two autosomal dominant disorders characterized by episodes of severe pain, inherited erythromelalgia (IEM) and paroxysmal extreme pain disorder (PEPD) have been directly linked to mutations that enhance the function of sodium channel Nav1.7. Pain attacks are accompanied by reddening of the skin in both disorders. Nav1.7 is known to be expressed at relatively high levels within both dorsal root ganglion (DRG) and sympathetic ganglion neurons, and mutations that enhance the activity of Nav1.7 have been shown to have profound effects on the excitability of both cell-types, suggesting that dysfunction of sympathetic and/or sensory fibers, which release vasoactive peptides at skin vasculature, may contribute to skin reddening in IEM and PEPD. RESULTS In the present study, we demonstrate that smooth muscle cells of cutaneous arterioles and arteriole-venule shunts (AVS) in the skin express sodium channel Nav1.7. Moreover, Nav1.7 is expressed by endothelial cells lining the arterioles and AVS and by sensory and sympathetic fibers innervating these vascular elements. CONCLUSIONS These observations suggest that the activity of mutant Nav1.7 channels in smooth muscle cells of skin vasculature and innervating sensory and sympathetic fibers contribute to the skin reddening and/or pain in IEM and PEPD.
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Affiliation(s)
- Frank L Rice
- Integrated Tissue Dynamics, LLC, Rensselaer, NY, 12144, USA.
| | - Phillip J Albrecht
- Integrated Tissue Dynamics, LLC, Rensselaer, NY, 12144, USA. .,Department of Neurology, Albany Medical College, Albany, NY, 12209, USA.
| | - James P Wymer
- Department of Neurology, Albany Medical College, Albany, NY, 12209, USA.
| | - Joel A Black
- Center for Neuroscience & Regeneration Research, Yale University School of Medicine, West Haven, CT, 06516, USA. .,Rehabilitation Research Center, VA Connecticut Healthcare System, West Haven, CT, 06516, USA.
| | - Ingemar Sj Merkies
- Department of Neurology, Spaarne Hospital, Hoofddorp, the Netherlands. .,Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Center, Maastricht, the Netherlands.
| | - Stephen G Waxman
- Center for Neuroscience & Regeneration Research, Yale University School of Medicine, West Haven, CT, 06516, USA. .,Rehabilitation Research Center, VA Connecticut Healthcare System, West Haven, CT, 06516, USA.
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Muñoz-Islas E, González-Hernández A, Lozano-Cuenca J, Ramírez-Rosas MB, Medina-Santillán R, Centurión D, MaassenVanDenBrink A, Villalón CM. Inhibitory effect of chronic oral treatment with fluoxetine on capsaicin-induced external carotid vasodilatation in anaesthetised dogs. Cephalalgia 2015; 35:1041-53. [DOI: 10.1177/0333102414566818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 12/08/2014] [Indexed: 01/30/2023]
Abstract
Background During migraine, capsaicin-sensitive trigeminal sensory nerves release calcitonin gene-related peptide (CGRP), resulting in cranial vasodilatation and central nociception. Moreover, 5-HT is involved in the pathophysiology of migraine and depression. Interestingly, some limited lines of evidence suggest that fluoxetine may be effective in migraine prophylaxis, but the underlying mechanisms are uncertain. Hence, this study investigated the canine external carotid vasodilator responses to capsaicin, α-CGRP and acetylcholine before and after acute and chronic oral treatment with fluoxetine. Methods Forty-eight vagosympathectomised male mongrel dogs were prepared to measure blood pressure, heart rate and external carotid blood flow. The thyroid artery was cannulated for infusions of agonists. In 16 of these dogs, a spinal cannula was inserted (C1–C3) for infusions of 5-HT. Results The external carotid vasodilator responses to capsaicin, α-CGRP and acetylcholine remained unaffected after intracarotid or i.v. fluoxetine. In contrast, the vasodilator responses to capsaicin, but not those to α-CGRP or acetylcholine, were inhibited after chronic oral treatment with fluoxetine (300 µg/kg; for 90 days) or intrathecal 5-HT. Conclusions Chronic oral fluoxetine inhibited capsaicin-induced external carotid vasodilatation, and this inhibition could partly explain its potential prophylactic antimigraine action.
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Affiliation(s)
| | | | | | | | | | | | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus Medical Center, The Netherlands
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Albrecht PJ, Hou Q, Argoff CE, Storey JR, Wymer JP, Rice FL. Excessive peptidergic sensory innervation of cutaneous arteriole-venule shunts (AVS) in the palmar glabrous skin of fibromyalgia patients: implications for widespread deep tissue pain and fatigue. Pain Med 2013; 14:895-915. [PMID: 23691965 DOI: 10.1111/pme.12139] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine if peripheral neuropathology exists among the innervation of cutaneous arterioles and arteriole-venule shunts (AVS) in fibromyalgia (FM) patients. SETTING Cutaneous arterioles and AVS receive a convergence of vasoconstrictive sympathetic innervation, and vasodilatory small-fiber sensory innervation. Given our previous findings of peripheral pathologies in chronic pain conditions, we hypothesized that this vascular location may be a potential site of pathology and/or serotonergic and norepinephrine reuptake inhibitors (SNRI) drug action. SUBJECTS Twenty-four female FM patients and nine female healthy control subjects were enrolled for study, with 14 additional female control subjects included from previous studies. AVS were identified in hypothenar skin biopsies from 18/24 FM patient and 14/23 control subjects. METHODS Multimolecular immunocytochemistry to assess different types of cutaneous innervation in 3 mm skin biopsies from glabrous hypothenar and trapezius regions. RESULTS AVS had significantly increased innervation among FM patients. The excessive innervation consisted of a greater proportion of vasodilatory sensory fibers, compared with vasoconstrictive sympathetic fibers. In contrast, sensory and sympathetic innervation to arterioles remained normal. Importantly, the sensory fibers express α2C receptors, indicating that the sympathetic innervation exerts an inhibitory modulation of sensory activity. CONCLUSIONS The excessive sensory innervation to the glabrous skin AVS is a likely source of severe pain and tenderness in the hands of FM patients. Importantly, glabrous AVS regulate blood flow to the skin in humans for thermoregulation and to other tissues such as skeletal muscle during periods of increased metabolic demand. Therefore, blood flow dysregulation as a result of excessive innervation to AVS would likely contribute to the widespread deep pain and fatigue of FM. SNRI compounds may provide partial therapeutic benefit by enhancing the impact of sympathetically mediated inhibitory modulation of the excess sensory innervation.
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Marichal-Cancino BA, González-Hernández A, Manrique-Maldonado G, Ruiz-Salinas II, Altamirano-Espinoza AH, MaassenVanDenBrink A, Villalón CM. Intrathecal dihydroergotamine inhibits capsaicin-induced vasodilatation in the canine external carotid circulation via GR127935- and rauwolscine-sensitive receptors. Eur J Pharmacol 2012; 692:69-77. [DOI: 10.1016/j.ejphar.2012.07.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/22/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022]
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Villalón CM, Galicia-carreón J, González-hernández A, Marichal-cancino BA, Manrique-maldonado G, Centurión D. Pharmacological evidence that spinal α2C- and, to a lesser extent, α2A-adrenoceptors inhibit capsaicin-induced vasodilatation in the canine external carotid circulation. Eur J Pharmacol 2012; 683:204-10. [DOI: 10.1016/j.ejphar.2012.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 03/02/2012] [Accepted: 03/06/2012] [Indexed: 11/24/2022]
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Gyires K, Zádori ZS, Török T, Mátyus P. α2-Adrenoceptor subtypes-mediated physiological, pharmacological actions. Neurochem Int 2009; 55:447-53. [DOI: 10.1016/j.neuint.2009.05.014] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 05/16/2009] [Accepted: 05/18/2009] [Indexed: 11/29/2022]
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Muñoz-Islas E, Lozano-Cuenca J, González-Hernández A, Ramírez-Rosas MB, Sánchez-López A, Centurión D, Maassenvandenbrink A, Villalón CM. Spinal sumatriptan inhibits capsaicin-induced canine external carotid vasodilatation via 5-HT1B rather than 5-HT1D receptors. Eur J Pharmacol 2009; 615:133-8. [PMID: 19460365 DOI: 10.1016/j.ejphar.2009.04.070] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 04/16/2009] [Accepted: 04/29/2009] [Indexed: 11/20/2022]
Abstract
Migraine is a neurovascular disorder associated with trigeminal activation, vasodilatation and trigeminal release of calcitonin gene-related peptide (CGRP). The antimigraine properties of triptans may be due to: i) vasoconstriction of the carotid arterial bed via 5-HT(1B) receptors; and ii) inhibition of CGRP release from trigeminal nerves, via 5-HT(1B/1D) receptors. This study investigated the effects of intrathecally administered sumatriptan (a 5-HT(1B/1D) receptor agonist) and PNU-142633 (a 5-HT(1D) receptor agonist) on the canine external carotid vasodilator responses to capsaicin, alpha-CGRP and acetylcholine. For this purpose, 42 mongrel dogs were anaesthetised with sodium pentobarbitone and, subsequently, vagosympathectomized. The animals were prepared to measure arterial blood pressure, heart rate and external carotid blood flow; the thyroid artery was cannulated for infusion of agonists. 1-min intracarotid (i.c.) continuous infusions of capsaicin, alpha-CGRP and acetylcholine produced dose-dependent increases in external carotid blood flow without affecting arterial blood pressure or heart rate. These vasodilator responses remained unaffected after intrathecal (i.t.) administration of physiological saline (0.5 ml) or PNU-142633 (300-1000 microg); in contrast, i.t. sumatriptan (300-1000 microg) significantly inhibited the vasodilator responses to capsaicin, but not those to alpha-CGRP or acetylcholine. Furthermore, i.t. administration of SB224289 (a 5-HT(1B) receptor antagonist), but not of BRL15572 (a 5-HT(1D) receptor antagonist), abolished the above inhibition by sumatriptan. These results suggest that sumatriptan-induced inhibition of the external carotid vasodilatation to capsaicin involves a central mechanism mainly mediated by 5-HT(1B) receptors.
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