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Abstract
Migraine is an episodic and popular headache disorder. Migraine arises from a primary cerebral dysfunction that leads to activation of trigeminovascualr system. In the 1940s cerebral arterial constriction and the following enhanced dilatation was considered to induce migraine attack. Next, the cortical neuronal change that is well linked to the migraine aura was considered to be primary mechanism of migraine attack. Recently, the trigeminovascular system has a main role in the pathophysiological mechanism of the migraine. From the animal studies, cortical spreading depression (CSD) may induce the activation of the trigeminovascular system and may be a trigger of the migraine pathological mechanism. Also the activation or the functional change of brainstem nuclei, involving periaqueductal grey matter, raphe nuclei, and locus ceruleus, may be a trigger of the migraine attack. We have showed that the level of plasma orexin-A in the migraine patients during headache free period is lower than that of control. From the animal experiments, we also showed that intracerebroventricular injection of orexin induces the increase in the cerebral cortical blood flow, and that the intraarterial application of orexin cannot increase the cerebral blood flow. We consider that orexinegic neurons in the lateral hypothalamus may be a generator of migraine.
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Affiliation(s)
- Junichi Hamada
- Department of Neurology, Kitasato University School of Medicine
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102
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Durham PL. Inhibition of calcitonin gene-related peptide function: a promising strategy for treating migraine. Headache 2009; 48:1269-75. [PMID: 18808507 DOI: 10.1111/j.1526-4610.2008.01215.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The neuropeptide calcitonin gene-related peptide (CGRP) is implicated in the underlying pathology of migraine. Serum levels of CGRP, which are elevated during a migraine attack, have been reported to return to normal with alleviation of pain. In addition, CGRP administration has been shown to cause a migraine-like headache in susceptible individuals. Importantly, CGRP receptors are found on many cell types within the trigeminovascular system that are thought to play important roles in controlling inflammatory and nociceptive processes. Based on these findings, it was proposed that blockage of CGRP receptor function and, hence, the physiological effects of CGRP would be effective in aborting a migraine attack. This review will summarize key preclinical data that support the therapeutic potential of using CGRP receptor antagonists or molecules that bind CGRP within the context of current neurovascular theories on migraine pathology.
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Affiliation(s)
- Paul L Durham
- Department of Biology, Missouri State University, Springfield, MO 65897, USA
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103
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Tottene A, Conti R, Fabbro A, Vecchia D, Shapovalova M, Santello M, van den Maagdenberg AMJM, Ferrari MD, Pietrobon D. Enhanced excitatory transmission at cortical synapses as the basis for facilitated spreading depression in Ca(v)2.1 knockin migraine mice. Neuron 2009; 61:762-73. [PMID: 19285472 DOI: 10.1016/j.neuron.2009.01.027] [Citation(s) in RCA: 247] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 12/15/2008] [Accepted: 01/27/2009] [Indexed: 11/25/2022]
Abstract
Migraine is a common disabling brain disorder. A subtype of migraine with aura (familial hemiplegic migraine type 1: FHM1) is caused by mutations in Ca(V)2.1 (P/Q-type) Ca(2+) channels. Knockin mice carrying a FHM1 mutation show increased neuronal P/Q-type current and facilitation of induction and propagation of cortical spreading depression (CSD), the phenomenon that underlies migraine aura and may activate migraine headache mechanisms. We studied cortical neurotransmission in neuronal microcultures and brain slices of FHM1 mice. We show gain of function of excitatory neurotransmission due to increased action-potential-evoked Ca(2+) influx and increased probability of glutamate release at pyramidal cell synapses but unaltered inhibitory neurotransmission at fast-spiking interneuron synapses. Using an in vitro model of CSD, we show a causative link between enhanced glutamate release and CSD facilitation. The synapse-specific effect of FHM1 mutations points to disruption of excitation-inhibition balance and neuronal hyperactivity as the basis for episodic vulnerability to CSD ignition in migraine.
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Affiliation(s)
- Angelita Tottene
- Department of Biomedical Sciences, University of Padova and CNR Institute of Neuroscience, Viale G. Colombo 3, Padua, Italy
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104
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Hansen JM, Petersen J, Wienecke T, Olsen KS, Jensen LT, Ashina M. Sumatriptan does not change calcitonin gene-related peptide in the cephalic and extracephalic circulation in healthy volunteers. J Headache Pain 2009; 10:85-91. [PMID: 19266171 PMCID: PMC3451653 DOI: 10.1007/s10194-009-0102-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Accepted: 01/20/2009] [Indexed: 11/26/2022] Open
Abstract
Triptans are effective and well tolerated in acute migraine management but their exact mechanism of action is still debated. Triptans might exert their antimigraine effect by reducing the levels of circulating calcitonin gene-related peptide (CGRP). To examine this question, we examined whether sumatriptan modulate the baseline CGRP levels in vivo, under conditions without trigeminovascular system activation. We sampled blood from the internal and external jugular, the cubital veins, and the radial artery before and after administration of subcutaneous sumatriptan in 16 healthy volunteers. Repeated-measure ANOVA showed no interaction between catheter and time of sampling and thus no significant difference in CGRP between the four catheters (P=0.75). CGRP did not change over time in the four compartments (P>0.05). The relative changes in CGRP between baseline and maximal sumatriptan concentration did not differ between the four vascular compartments (P=0.49). It was found that Sumatriptan did not change the levels of circulating CGRP in the intra or extracerebral circulation in healthy volunteers. This speaks against a direct CGRP-reducing effect of sumatriptan in vivo in humans when the trigemino vascular system is not activated.
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Affiliation(s)
- Jakob Møller Hansen
- Danish Headache Center and Department of Neurology, Faculty of Health Sciences, Glostrup Hospital, University of Copenhagen, Nordre Ringvej 57, Bolig 23-24, Glostrup, 2600 Copenhagen, Denmark.
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105
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Gargus JJ. Genetic calcium signaling abnormalities in the central nervous system: seizures, migraine, and autism. Ann N Y Acad Sci 2009; 1151:133-56. [PMID: 19154521 DOI: 10.1111/j.1749-6632.2008.03572.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The calcium ion is one of the most versatile, ancient, and universal of biological signaling molecules, known to regulate physiological systems at every level from membrane potential and ion transporters to kinases and transcription factors. Disruptions of intracellular calcium homeostasis underlie a host of emerging diseases, the calciumopathies. Cytosolic calcium signals originate either as extracellular calcium enters through plasma membrane ion channels or from the release of an intracellular store in the endoplasmic reticulum (ER) via inositol triphosphate receptor and ryanodine receptor channels. Therefore, to a large extent, calciumopathies represent a subset of the channelopathies, but include regulatory pathways and the mitochondria, the major intracellular calcium repository that dynamically participates with the ER stores in calcium signaling, thereby integrating cellular energy metabolism into these pathways, a process of emerging importance in the analysis of the neurodegenerative and neuropsychiatric diseases. Many of the calciumopathies are common complex polygenic diseases, but leads to their understanding come most prominently from rare monogenic channelopathy paradigms. Monogenic forms of common neuronal disease phenotypes-such as seizures, ataxia, and migraine-produce a constitutionally hyperexcitable tissue that is susceptible to periodic decompensations. The gene families and genetic lesions underlying familial hemiplegic migraine, FHM1/CACNA1A, FHM2/ATP1A2, and FHM3/SCN1A, and monogenic mitochondrial migraine syndromes, provide a robust platform from which genes, such as CACNA1C, which encodes the calcium channel mutated in Timothy syndrome, can be evaluated for their role in autism and bipolar disease.
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Affiliation(s)
- J Jay Gargus
- Department of Physiology & Biophysics, Section of Human Genetics, School of Medicine, University of California-Irvine, Irvine, CA 92697, USA.
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106
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Cortical inhibition and habituation to evoked potentials: relevance for pathophysiology of migraine. J Headache Pain 2009; 10:77-84. [PMID: 19209386 PMCID: PMC3451650 DOI: 10.1007/s10194-008-0095-x] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Accepted: 12/31/2008] [Indexed: 11/21/2022] Open
Abstract
Dysfunction of neuronal cortical excitability has been supposed to play an important role in etiopathogenesis of migraine. Neurophysiological techniques like evoked potentials (EP) and in the last years non-invasive brain stimulation techniques like transcranial magnetic stimulation (TMS) and transcranial direct current stimulation gave important contribution to understanding of such issue highlighting possible mechanisms of cortical dysfunctions in migraine. EP studies showed impaired habituation to repeated sensorial stimulation and this abnormality was confirmed across all sensorial modalities, making defective habituation a neurophysiological hallmark of the disease. TMS was employed to test more directly cortical excitability in visual cortex and then also in motor cortex. Contradictory results have been reported pointing towards hyperexcitability or on the contrary to reduced preactivation of sensory cortex in migraine. Other experimental evidence speaks in favour of impairment of inhibitory circuits and analogies have been proposed between migraine and conditions of sensory deafferentation in which down-regulation of GABA circuits is considered the more relevant pathophysiological mechanism. Whatever the mechanism involved, it has been found that repeated sessions of high-frequency rTMS trains that have been shown to up-regulate inhibitory circuits could persistently normalize habituation in migraine. This could give interesting insight into pathophysiology establishing a link between cortical inhibition and habituation and opening also new treatment strategies in migraine.
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107
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Differential expression of BK channel isoforms and β-subunits in rat neuro-vascular tissues. BIOCHIMICA ET BIOPHYSICA ACTA-BIOMEMBRANES 2009; 1788:380-9. [DOI: 10.1016/j.bbamem.2008.10.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 09/18/2008] [Accepted: 10/06/2008] [Indexed: 12/30/2022]
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108
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109
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Eikermann-Haerter K, Dileköz E, Kudo C, Savitz SI, Waeber C, Baum MJ, Ferrari MD, van den Maagdenberg AM, Moskowitz MA, Ayata C. Genetic and hormonal factors modulate spreading depression and transient hemiparesis in mouse models of familial hemiplegic migraine type 1. J Clin Invest 2009; 119:99-109. [PMID: 19104150 PMCID: PMC2613474 DOI: 10.1172/jci36059] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 10/08/2008] [Indexed: 11/17/2022] Open
Abstract
Familial hemiplegic migraine type 1 (FHM1) is an autosomal dominant subtype of migraine with aura that is associated with hemiparesis. As with other types of migraine, it affects women more frequently than men. FHM1 is caused by mutations in the CACNA1A gene, which encodes the alpha1A subunit of Cav2.1 channels; the R192Q mutation in CACNA1A causes a mild form of FHM1, whereas the S218L mutation causes a severe, often lethal phenotype. Spreading depression (SD), a slowly propagating neuronal and glial cell depolarization that leads to depression of neuronal activity, is the most likely cause of migraine aura. Here, we have shown that transgenic mice expressing R192Q or S218L FHM1 mutations have increased SD frequency and propagation speed; enhanced corticostriatal propagation; and, similar to the human FHM1 phenotype, more severe and prolonged post-SD neurological deficits. The susceptibility to SD and neurological deficits is affected by allele dosage and is higher in S218L than R192Q mutants. Further, female S218L and R192Q mutant mice were more susceptible to SD and neurological deficits than males. This sex difference was abrogated by ovariectomy and senescence and was partially restored by estrogen replacement, implicating ovarian hormones in the observed sex differences in humans with FHM1. These findings demonstrate that genetic and hormonal factors modulate susceptibility to SD and neurological deficits in FHM1 mutant mice, providing a potential mechanism for the phenotypic diversity of human migraine and aura.
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Affiliation(s)
- Katharina Eikermann-Haerter
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Ergin Dileköz
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Chiho Kudo
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Sean I. Savitz
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Christian Waeber
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Michael J. Baum
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Michel D. Ferrari
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Arn M.J.M. van den Maagdenberg
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Michael A. Moskowitz
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
| | - Cenk Ayata
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology,
Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts, USA.
Department of Neurology, University of Duisburg-Essen, Essen,
Germany. Department of Neurology, University of Texas Medical School at
Houston, Houston, Texas, USA. Department of Biology, Boston University,
Boston, Massachusetts, USA. Department of Neurology and
Department of Human Genetics, Leiden University Medical Center, Leiden,
The Netherlands. Stroke Service and Neuroscience Intensive Care Unit,
Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,
Massachusetts, USA
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110
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Abstract
Migraine is an episodic headache disorder affecting as many as 10% of people worldwide. Familial hemiplegic migraine (FHM) is an autosomal dominant subtype of severe migraine accompanied by visual disturbances known as aura. Migrainous aura is caused by cortical spreading depression (CSD) - a slowly advancing wave of tissue depolarization in the cortex. More than half of FHM cases are caused by mutations in the CACNA1A gene, which encodes a neuronal Cav2.1 Ca2+ channel, resulting in increased Ca2+ flow into dendrites and excessive release of the excitatory neurotransmitter glutamate. In this issue of the JCI, Eikermann-Haerter et al. show that transgenic mice with FHM-associated mutations in Cacna1a have increased susceptibility to CSD compared with wild-type animals, likely due to augmentation of excitatory neurotransmission (see the related article beginning on page 99). Additional as-yet-undefined channel mutations may similarly render the migraine brain more susceptible to the initiation of CSD, with implications not only for the genesis of migraine but also for the hypoxic injury that accompanies its worst manifestation, complicated migraine.
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Affiliation(s)
- Takahiro Takano
- Division of Glial Disease and Therapeutics, Center for Translational Neuromedicine, Department of Neurosurgery, University of Rochester, Rochester, New York 14642, USA
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111
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Martella G, Costa C, Pisani A, Cupini LM, Bernardi G, Calabresi P. Antiepileptic Drugs on Calcium Currents Recorded from Cortical and PAG Neurons: Therapeutic Implications for Migraine. Cephalalgia 2008; 28:1315-26. [DOI: 10.1111/j.1468-2982.2008.01682.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cortex and periaqueductal grey (PAG) play a major role in the pathophysiology of migraine. Some antiepileptic drugs (AEDs) influence the activity of these structures by modulating high-voltage-activated (HVA) Ca2+ channels and are effective in migraine prevention. The aim of the present study was to investigate the expression of total HVA Ca2+ channels in cortical and PAG neurons and to study the differential action of AEDs on these channels. Isolated neurons were visually identified based on morphological criteria. HVA currents were recorded by whole-cell patch-clamp technique. The distribution ratio of L-, N-, P-, Q- and R-type HVA Ca2+ channels was different between cortical and PAG neurons. In particular, we found that P- and Q-type HVA Ca2+ channels were more expressed in PAG neurons than in cortical cells, whereas L- and R-type HVA Ca2+ channels showed an opposite distribution. Interestingly, N-type HVA Ca2+ channels were equally distributed in these two neuronal populations. A differential sensitivity to AEDs of HVA Ca2+ channels located on cortical and PAG neurons was observed for topiramate (TPM), but not for lamotrigine (LTG) or levetiracetam (LEV). In fact, whereas both LTG and LEV were equally effective and potent in inhibiting HVA Ca2+ currents in the two neuronal populations, TPM showed a much higher potency and efficacy in blocking these currents in PAG neurons than in cortical pyramidal cells. TPM, in fact, inhibited N-, P- and L-type channels in PAG neurons, whereas in cortical neurons this AED modulated only P- and L-type channels. Unlike the other AEDs investigated, valproic acid did not affect HVA Ca2+ currents in cortical and PAG neurons. The negative modulation of specific subtypes of HVA Ca2+ channels by various AEDs can restore normal electrical activity in target brain areas such as cortex and PAG, providing interesting therapeutic approaches in migraine prevention.
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Affiliation(s)
- G Martella
- Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma ‘Tor Vergata’
- Laboratorio di Neurofisiologia, Fondazione Santa Lucia, IRCCS c/o CERC, Rome
| | - C Costa
- Laboratorio di Neurofisiologia, Fondazione Santa Lucia, IRCCS c/o CERC, Rome
- Clinica Neurologica, Dip. Specialità Medico Chirurgiche e Sanità Pubblica, Università di Perugia, Ospedale Santa Maria della Misericordia, Perugia
| | - A Pisani
- Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma ‘Tor Vergata’
- Laboratorio di Neurofisiologia, Fondazione Santa Lucia, IRCCS c/o CERC, Rome
| | - LM Cupini
- Cinica Neurologica, Ospedale S. Eugenio, Rome, Italy
| | - G Bernardi
- Clinica Neurologica, Dipartimento di Neuroscienze, Università di Roma ‘Tor Vergata’
- Laboratorio di Neurofisiologia, Fondazione Santa Lucia, IRCCS c/o CERC, Rome
| | - P Calabresi
- Laboratorio di Neurofisiologia, Fondazione Santa Lucia, IRCCS c/o CERC, Rome
- Clinica Neurologica, Dip. Specialità Medico Chirurgiche e Sanità Pubblica, Università di Perugia, Ospedale Santa Maria della Misericordia, Perugia
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112
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A novel de novo nonsense mutation in ATP1A2 associated with sporadic hemiplegic migraine and epileptic seizures. J Neurol Sci 2008; 273:123-6. [PMID: 18644608 DOI: 10.1016/j.jns.2008.06.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 06/05/2008] [Indexed: 12/14/2022]
Abstract
Familial hemiplegic migraine (FHM) is a severe dominant form of migraine with aura associated with transient hemiparesis. Several other neurological signs and symptoms can be associated with FHM such as cerebellar abnormalities, cerebral edema and coma after minor head trauma, epileptic seizures and mental retardation. The sporadic form of hemiplegic migraine named SHM, presents with identical clinical symptoms. Here we report a case of a young hemiplegic migraine patient, 11 years old, who had the first hemiplegic attack at the age of 10 years. This patient has a clinical history of epileptic seizures in the childhood successfully controlled with drug therapy. No familiarity for any type of migraine or seizures can be observed within the paternal or maternal line. The patient who can therefore be considered a sporadic case, carries a novel de novo nonsense mutation p.Tyr1009X in the ATP1A2 gene (FHM2), leading to a truncated alpha-2 subunit of the Na+/K+-ATPase pump thus lacking the last 11 amino acids. The novel mutation identified confirms the role of FHM2 gene in forms of hemiplegic migraine associated with epilepsy with both familial and sporadic occurrence, and expands the spectrum of mutations related to these forms of the disease.
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113
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Weiss N, Sandoval A, Felix R, Van den Maagdenberg A, De Waard M. The S218L familial hemiplegic migraine mutation promotes deinhibition of Ca(v)2.1 calcium channels during direct G-protein regulation. Pflugers Arch 2008; 457:315-26. [PMID: 18581134 DOI: 10.1007/s00424-008-0541-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 05/20/2008] [Accepted: 06/03/2008] [Indexed: 12/01/2022]
Abstract
Familial hemiplegic migraine type 1 (FHM-1) is caused by mutations in CACNA1A, the gene encoding for the Ca(v)2.1 subunit of voltage-gated calcium channels. Although various studies attempted to determine biophysical consequences of these mutations on channel activity, it remains unclear exactly how mutations can produce a FHM-1 phenotype. A lower activation threshold of mutated channels resulting in increased channel activity has been proposed. However, hyperactivity may also be caused by a reduction of the inhibitory pathway carried by G-protein-coupled-receptor activation. The aim of this study is to determine functional consequences of the FHM-1 S218L mutation on direct G-protein regulation of Ca(v)2.1 channels. In HEK 293 cells, DAMGO activation of human mu-opioid receptors induced a 55% Ba(2+) current inhibition through both wild-type and S218L mutant Ca(v)2.1 channels. In contrast, this mutation considerably accelerates the kinetic of current deinhibition following channel activation by 1.7- to 2.3-fold depending on membrane potential values. Taken together, these data suggest that the S218L mutation does not affect G-protein association onto the channel in the closed state but promotes its dissociation from the activated channel, thereby decreasing the inhibitory G-protein pathway. Similar results were obtained with the R192Q FHM-1 mutation, although of lesser amplitude, which seems in line with the less severe associated clinical phenotype in patients. Functional consequences of FHM-1 mutations appear thus as the consequence of the alteration of both intrinsic biophysical properties and of the main inhibitory G-protein pathway of Ca(v)2.1 channels. The present study furthers molecular insight in the physiopathology of FHM-1.
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Affiliation(s)
- Norbert Weiss
- INSERM U836, Site Santé la Tronche, BP 170, 38042, Grenoble Cedex 9, France
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114
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Colombo B, Dalla Libera D, Annovazzi PO, Comi G. Headache therapy with neuronal stabilising drugs. Neurol Sci 2008; 29 Suppl 1:S131-6. [DOI: 10.1007/s10072-008-0904-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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115
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Thomsen LL, Oestergaard E, Bjornsson A, Stefansson H, Fasquel AC, Gulcher J, Stefansson K, Olesen J. Screen for CACNA1A and ATP1A2 mutations in sporadic hemiplegic migraine patients. Cephalalgia 2008; 28:914-21. [PMID: 18513263 DOI: 10.1111/j.1468-2982.2008.01599.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate the involvement of the CACNA1A and ATP1A2 gene in a population-based sample of sporadic hemiplegic migraine (SHM). Patients with SHM (n = 105) were identified in a nationwide search in the Danish population. We sequenced all exons and promoter regions of the CACNA1A and ATP1A2 genes in 100 patients with SHM to search for possible SHM mutations. Novel DNA variants were discovered in eight SHM patients, four in exons of the CACNA1A gene and four in exons of the ATP1A2 gene. Six of the variants were considered non-pathogenic. The causal role of the two remaining DNA variants is unknown until functional studies have been made or independent genetic evidence is discovered. Only very few DNA variants were identified in 100 SHM patients, and regardless of whether the identified variants are causal the CACNA1A and ATP1A2 genes are not major genes in SHM.
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Affiliation(s)
- L L Thomsen
- Danish Headache Centre, University of Copenhagen, Department of Neurology, Glostrup Hospital, Glostrup, Denmark.
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116
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Stam AH, Vanmolkot KRJ, Kremer HPH, Gärtner J, Brown J, Leshinsky-Silver E, Gilad R, Kors EE, Frankhuizen WS, Ginjaar HB, Haan J, Frants RR, Ferrari MD, van den Maagdenberg AMJM, Terwindt GM. CACNA1A R1347Q: a frequent recurrent mutation in hemiplegic migraine. Clin Genet 2008; 74:481-5. [PMID: 18400034 DOI: 10.1111/j.1399-0004.2008.00996.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Of the 18 missense mutations in the CACNA1A gene, which are associated with familial hemiplegic migraine type 1 (FHM1), only mutations S218L, R583Q and T666M were identified in more than two independent families. Including the four novel families presented here, of which two represent de novo cases, the R1347Q mutation has now been identified in six families. A genotype-phenotype comparison of R1347Q mutation carriers revealed a wide clinical spectrum ranging from (trauma triggered) hemiplegic migraine with and without ataxia, loss of consciousness and epilepsy. R1347Q is the third most frequent mutation in hemiplegic migraine patients and should therefore be screened with priority for confirmation of clinical diagnosis. This study clearly demonstrates that the availability of multiple families better reflects the full clinical spectrum associated with FHM1 mutations.
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Affiliation(s)
- A H Stam
- Department of Neurology and Clinical Genetic, Erasmus Medical Centre, Leiden, The Netherlands
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Deprez L, Weckhuysen S, Peeters K, Deconinck T, Claeys KG, Claes LR, Suls A, Van Dyck T, Palmini A, Matthijs G, Van Paesschen W, De Jonghe P. Epilepsy as part of the phenotype associated withATP1A2mutations. Epilepsia 2008; 49:500-8. [DOI: 10.1111/j.1528-1167.2007.01415.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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118
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Calcitonin gene-related peptide stimulation of nitric oxide synthesis and release from trigeminal ganglion glial cells. Brain Res 2008; 1196:22-32. [PMID: 18221935 DOI: 10.1016/j.brainres.2007.12.028] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2007] [Revised: 12/06/2007] [Accepted: 12/11/2007] [Indexed: 11/23/2022]
Abstract
Clinical and basic science data support an integral role of calcitonin gene-related peptide (CGRP) in migraine pathology. Following trigeminal nerve activation, afferent release of CGRP causes vasodilation while efferent release leads to pain. Although CGRP can also be secreted from cell bodies of trigeminal neurons located within the ganglion, the function of CGRP released in the ganglion is poorly understood. Initially, we showed that SNAP-25, a protein required for CGRP release, was localized in cell bodies of trigeminal ganglia neurons. We also found that satellite glial cells in the ganglia express the CGRP1 receptor protein RAMP1. To determine whether CGRP could directly activate glial cells, primary cultures of rat trigeminal ganglia were utilized to study the effects of CGRP on glial nitric oxide (NO) synthesis and release. Under our culture conditions, >95% of the cells expressed glial fibrillary acidic protein and RAMP1. While weak iNOS staining was observed in glia under basal conditions, CGRP treatment greatly increased glial iNOS expression and NO release. This stimulatory effect was blocked by the CGRP1 receptor antagonist, CGRP(8-37) peptide. Treatment of glial cultures with forskolin or cAMP also increased iNOS expression and stimulated NO release to levels similar to CGRP. To our knowledge, this is the first evidence that activation of CGRP1 receptors regulates glial iNOS and NO release. We propose that following trigeminal nerve activation, CGRP secretion from neuronal cell bodies activates satellite glial cells that release NO and initiate inflammatory events in the ganglia that contribute to peripheral sensitization in migraine.
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119
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120
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Cheng A, Wilson‐Pauwels L, Mazierski D, Wall S. Using the Principles of Interactive Cartography to Communicate the Mechanisms of Migraine Pain. J Vis Commun Med 2008; 31:103-9. [DOI: 10.1080/17453050802398702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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121
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Davies ML, Kirov SA, Andrew RD. Whole isolated neocortical and hippocampal preparations and their use in imaging studies. J Neurosci Methods 2007; 166:203-16. [PMID: 17765319 PMCID: PMC2100436 DOI: 10.1016/j.jneumeth.2007.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 07/10/2007] [Accepted: 07/11/2007] [Indexed: 11/19/2022]
Abstract
This study shows that two whole isolated preparations from the young mouse, the neocortical 'slab' and the hippocampal formation, are useful for imaging studies requiring both global monitoring using light transmittance (LT) imaging and high resolution cellular monitoring using 2-photon laser scanning microscopy (2PLSM). These preparations share advantages with brain slices such as maintaining intrinsic neuronal properties and avoiding cardiac or respiratory movement. Important additional advantages include the maintenance of all local input and output pathways, the absence of surfaces injured by slicing and the preservation of three-dimensional tissue structure. Using evoked extracellular field recording, we demonstrate long-term (hours) viability of both whole preparations. We then show that propagating cortical events such as anoxic depolarization (AD) and spreading depression (SD) can be imaged in both preparations, yielding results comparable to those in brain slices but retaining the tissue's three-dimensional structure. Using transgenic mice expressing green fluorescent protein (GFP) in pyramidal and granule cell neurons, 2PLSM confirms that these preparations are free of the surface damage observed in sliced brain tissue. Moreover the neurons undergo swelling with accompanying dendritic beading following AD induced by simulated ischemia, similar to cortical damage described in vivo.
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Affiliation(s)
- Melissa L. Davies
- Department of Anatomy & Cell Biology and The Centre for Neuroscience Studies Queen’s University, Kingston, ON
| | - Sergei A. Kirov
- Department of Neurosurgery Medical College of Georgia, Augusta, GA
| | - R. David Andrew
- Department of Anatomy & Cell Biology and The Centre for Neuroscience Studies Queen’s University, Kingston, ON
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122
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Ceruti S, Fumagalli M, Villa G, Verderio C, Abbracchio MP. Purinoceptor-mediated calcium signaling in primary neuron-glia trigeminal cultures. Cell Calcium 2007; 43:576-90. [PMID: 18031810 DOI: 10.1016/j.ceca.2007.10.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 08/23/2007] [Accepted: 10/04/2007] [Indexed: 10/22/2022]
Abstract
Receptors for extracellular nucleotides (the P2X-calcium channels and the phospholipase C-coupled P2Y receptors) play key roles in pain signaling, but little is known on their function in trigeminal ganglia, whose hyperactivation leads to the development of migraine pain. Here we characterize calcium signaling via P2X(3) and P2Y receptors in primary mouse neuron-glia trigeminal cultures. Comparison with intact ganglion showed that, in dissociated cultures, sensory neurons retain, at least in part, their physical relationships with satellite glia. RT-PCR indicated expression of P2X(2)/P2X(3) (confirmed by immunocytochemistry) and of all cloned P2Y receptors. Single-cell calcium imaging with subtype-selective P2-agonists/antagonists revealed presence of functional neuronal P2X(3), as well as of ADP-sensitive P2Y(1,12,13) and UTP-activated P2Y(2)/P2Y(4) receptors on both neurons and glia. Calcium responses were much higher in glia, that also responded to UDP, suggesting functional P2Y(6) receptors. To study whether trigeminal ganglia P2 receptors are modulated upon treatment with pro-inflammatory agents, cultures were acutely (up to 3 min) or chronically (24 h) exposed to bradykinin. This resulted in potentiation of algogenic P2X(3) receptor-mediated calcium responses followed by their down-regulation at 24 h. At this exposure time, P2Y receptors responses in satellite glia were instead upregulated, suggesting a complex modulation of P2 receptors in pain signaling.
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Affiliation(s)
- Stefania Ceruti
- Laboratory of Molecular and Cellular Pharmacology of Purinergic Transmission, Department of Pharmacological Sciences, University of Milan, via Balzaretti 9, 20133 Milan, Italy
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123
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Willson J, Kapur S. Apnoeic spells following general anaesthesia in a patient with familial hemiplegic migraine. Anaesthesia 2007; 62:956-8. [PMID: 17697227 DOI: 10.1111/j.1365-2044.2007.05144.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hemiplegic migraine is an unusual variant of migraine, characterised by a temporary hemiparesis or hemiplegia associated with headache. We report a patient with hemiplegic migraine who developed atypical migraine with apnoeic spells, aphasia and hemiparesis following general anaesthesia. We review the clinical features of hemiplegic migraine and the considerations for its anaesthetic management.
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Affiliation(s)
- J Willson
- Department of Anaesthesia and Intensive Care, Russells Hall Hospital, Dudley, West Midlands DY1 2HQ, UK.
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124
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Abstract
Since the initial identification of native calcium currents, significant progress has been made towards our understanding of the molecular and cellular contributions of voltage-gated calcium channels in multiple physiological processes. Moreover, we are beginning to comprehend their pathophysiological roles through both naturally occurring channelopathies in humans and mice and through targeted gene deletions. The data illustrate that small perturbations in voltage-gated calcium channel function induced by genetic alterations can affect a wide variety of mammalian developmental, physiological and behavioral functions. At least in those instances wherein the channelopathies can be attributed to gain-of-function mechanisms, the data point towards new therapeutic strategies for developing highly selective calcium channel antagonists.
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125
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Thalakoti S, Patil VV, Damodaram S, Vause CV, Langford LE, Freeman SE, Durham PL. Neuron-glia signaling in trigeminal ganglion: implications for migraine pathology. Headache 2007; 47:1008-23; discussion 24-5. [PMID: 17635592 PMCID: PMC2268711 DOI: 10.1111/j.1526-4610.2007.00854.x] [Citation(s) in RCA: 228] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The goal of this study was to investigate neuronal-glial cell signaling in trigeminal ganglia under basal and inflammatory conditions using an in vivo model of trigeminal nerve activation. BACKGROUND Activation of trigeminal ganglion nerves and release of calcitonin gene-related peptide (CGRP) are implicated in the pathology of migraine. Cell bodies of trigeminal neurons reside in the ganglion in close association with glial cells. Neuron-glia interactions are involved in all stages of inflammation and pain associated with several central nervous system (CNS) diseases. However, the role of neuron-glia interactions within the trigeminal ganglion under normal and inflammatory conditions is not known. METHODS Sprague-Dawley rats were utilized to study neuron-glia signaling in the trigeminal ganglion. Initially, True Blue was used as a retrograde tracer to localize neuronal cell bodies in the ganglion by fluorescent microscopy and multiple image alignment. Dye-coupling studies were conducted under basal conditions and in response to capsaicin injection into the TMJ capsule. S100B and p38 expression in neurons and glia were determined by immunohistochemistry following chemical stimulation. CGRP levels in the ganglion were measured by radioimmunoassay in response to capsaicin. In addition, the effect of CGRP on the release of 19 different cytokines from cultured glial cells was investigated by protein microarray analysis. RESULTS In unstimulated control animals, True Blue was detected primarily in neuronal cell bodies localized in clusters within the ganglion corresponding to the V3 region (TMJ capsule), V2 region (whisker pad), or V1 region (eyebrow and eye). However, True Blue was detected in both neuronal cell bodies and adjacent glia in the V3 region of the ganglion obtained from animals injected with capsaicin. Dye movement into the surrounding glia correlated with the time after capsaicin injection. Chemical stimulation of V3 trigeminal nerves was found to increase the expression of the inflammatory proteins S100B and p38 in both neurons and glia within the V3 region. Unexpectedly, increased levels of these proteins were also observed in the V2 and V1 regions of the ganglion. CGRP and the vesicle docking protein SNAP-25 were colocalized in many neuronal cell bodies and processes. Decreased CGRP levels in the ganglion were observed 2 hours following capsaicin stimulation. Using protein microarray analysis, CGRP was shown to differentially regulate cytokine secretion from cultured trigeminal ganglion glia. CONCLUSIONS We demonstrated that activation of trigeminal neurons leads to changes in adjacent glia that involve communication through gap junctions and paracrine signaling. This is the first evidence, to our knowledge, of neuron-glia signaling via gap junctions within the trigeminal ganglion. Based on our findings, it is likely that neuronal-glial communication via gap junctions and paracrine signaling are involved in the development of peripheral sensitization within the trigeminal ganglion and, thus, are likely to play an important role in the initiation of migraine. Furthermore, we propose that propagation of inflammatory signals within the ganglion may help to explain commonly reported symptoms of comorbid conditions associated with migraine.
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Affiliation(s)
- Srikanth Thalakoti
- Department of Biology, Missouri State University, Springfield, MO 65897, USA
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126
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Abstract
Cortical spreading depression (CSD) is an electrophysiological phenomenon characterized by a wave of excitation followed by inhibition. The aura phase that precedes migraine headache in about 20-30% of migraineurs shares overlapping characteristics with CSD. Studies of rare autosomal-dominant forms of migraine with aura provide strong evidence that the threshold for evoking CSD and aura are related to neuronal excitability. Although the relationship between CSD and migraine without aura is not completely understood, the molecular abnormalities that predispose to migraine with aura illustrate the importance of physiologic events associated with neuronal hyperexcitability, and provide a basis for understanding a more generalized view of migraine.
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Affiliation(s)
- Katharina Eikermann-Haerter
- Department of Radiology, Stroke and Neurovascular Regulation Laboratory, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
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127
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van den Maagdenberg AMJM, Haan J, Terwindt GM, Ferrari MD. Migraine: gene mutations and functional consequences. Curr Opin Neurol 2007; 20:299-305. [PMID: 17495624 DOI: 10.1097/wco.0b013e3281338d1f] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Genetic and functional studies of mutations in familial hemiplegic migraine reveal a major role for disturbed ion transport. Gene identification in common, multifactorial migraine remains challenging. RECENT FINDINGS Several new mutations have been identified in FHM1, FHM2 and FHM3 genes. Functional consequences of familial hemiplegic migraine mutations point to an important role for cortical spreading depression in migraine pathophysiology. New genetic approaches have been tested in common migraine - novel chromosomal loci - but no gene variants have been identified. SUMMARY Identification and analysis of gene mutations in familial hemiplegic migraine revealed a major role for disturbed ion transport in this disorder. Cellular and transgenic mouse models of familial hemiplegic migraine genes suggest that increased potassium and glutamate play a role in the pathophysiology of the disorder. Despite progress, no genes have been discovered for common migraine.
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128
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Abstract
Clinical and pathophysiological evidences connect migraine and the cerebellum. Literature on documented cerebellar abnormalities in migraine, however, is relatively sparse. Cerebellar involvement may be observed in 4 types of migraines: in the widespread migraine with aura (MWA) and migraine without aura (MWoA) forms; in particular subtypes of migraine such as basilar-type migraine (BTM); and in the genetically driven autosomal dominant familial hemiplegic migraine (FHM) forms. Cerebellar dysfunction in migraineurs varies largely in severity, and may be subclinical. Purkinje cells express calcium channels that are related to the pathophysiology of both inherited forms of migraine and primary ataxias, mostly spinal cerebellar ataxia type 6 (SCA-6) and episodic ataxia type 2 (EA-2). Genetically driven ion channels dysfunction leads to hyperexcitability in the brain and cerebellum, possibly facilitating spreading depression waves in both locations. This review focuses on the cerebellar involvement in migraine, the relevant ataxias and their association with this primary headache, and discusses some of the pathophysiological processes putatively underlying these diseases.
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Affiliation(s)
- Maurice Vincent
- Hospital Universitário Clementino Fraga Filho, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Brazil
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129
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Abstract
Familial hemiplegic migraine (FHM) is a rare and genetically heterogeneous autosomal dominant subtype of migraine with aura. Mutations in the genes CACNA1A and SCNA1A, encoding the pore-forming alpha(1) subunits of the neuronal voltage-gated Ca2+ channels Ca(V)2.1 and Na+ channels Na(V)1.1, are responsible for FHM1 and FHM3, respectively, whereas mutations in ATP1A2, encoding the alpha2 subunit of the Na+, K+ adenosinetriphosphatase (ATPase), are responsible for FHM2. This review discusses the functional studies of two FHM1 knockin mice and of several FHM mutants in heterologous expression systems (12 FHM1, 8 FHM2, and 1 FHM3). These studies show the following: (1) FHM1 mutations produce gain-of-function of the Ca(V)2.1 channel and, as a consequence, increased Ca(V)2.1-dependent neurotransmitter release from cortical neurons and facilitation of in vivo induction and propagation of cortical spreading depression (CSD: the phenomenon underlying migraine aura); (2) FHM2 mutations produce loss-of-function of the alpha2 Na+,K+-ATPase; and (3) the FHM3 mutation accelerates recovery from fast inactivation of Na(V)1.5 (and presumably Na(V)1.1) channels. These findings are consistent with the hypothesis that FHM mutations share the ability of rendering the brain more susceptible to CSD by causing either excessive synaptic glutamate release (FHM1) or decreased removal of K+ and glutamate from the synaptic cleft (FHM2) or excessive extracellular K+ (FHM3). The FHM data support a key role of CSD in migraine pathogenesis and point to cortical hyperexcitability as the basis for vulnerability to CSD and to migraine attacks. Hence, they support novel therapeutic strategies that consider CSD and cortical hyperexcitability as key targets for preventive migraine treatment.
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Affiliation(s)
- Daniela Pietrobon
- Department of Biomedical Sciences, University of Padova, 35121 Padova, Italy.
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130
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Calabresi P, Galletti F, Rossi C, Sarchielli P, Cupini LM. Antiepileptic drugs in migraine: from clinical aspects to cellular mechanisms. Trends Pharmacol Sci 2007; 28:188-95. [PMID: 17337068 DOI: 10.1016/j.tips.2007.02.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Revised: 01/16/2007] [Accepted: 02/20/2007] [Indexed: 11/16/2022]
Abstract
Migraine and epilepsy share several clinical features, and epilepsy is a comorbid condition of migraine. Clinical studies have shown that some antiepileptic drugs are effective at preventing migraine attacks. A rationale for their use in migraine prophylaxis is the hypothesis that migraine and epilepsy share several common pathogenetic mechanisms. An imbalance between excitatory glutamate-mediated transmission and GABA-mediated inhibition in specific brain areas has been postulated in these two pathological conditions. Moreover, abnormal activation of voltage-operated ionic channels has been implicated in both migraine and epilepsy. Cortical spreading depression has been found to be involved in the pathophysiology of epilepsy, in addition to the generation of migraine aura.
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Affiliation(s)
- Paolo Calabresi
- Clinica Neurologica, Università degli Studi di Perugia, Ospedale S. Maria della Misericordia, Perugia 06156, Italy.
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131
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Felix R. Calcium channelopathies. Neuromolecular Med 2007; 8:307-18. [PMID: 16775382 DOI: 10.1385/nmm:8:3:307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2005] [Revised: 11/30/1999] [Accepted: 01/20/2006] [Indexed: 11/11/2022]
Abstract
Intracellular calcium ([Ca2+]i) is highly regulated in eukaryotic cells. The free [Ca2+]i is approximately four orders of magnitude less than that in the extracellular environment. It is, therefore, an electrochemical gradient favoring Ca2+ entry, and transient cellular activation increasing Ca2+ permeability will lead to a transient increase in [Ca2+]i. These transient rises of [Ca2+]i trigger or regulate diverse intracellular events, including metabolic processes, muscle contraction, secretion of hormones and neurotransmitters, cell differentiation, and gene expression. Hence, changes in [Ca2+]i act as a second messenger system coordinating modifications in the external environment with intracellular processes. Notably, information on the molecular genetics of the membrane channels responsible for the influx of Ca2+ ions has led to the discovery that mutations in these proteins are linked to human disease. Ca2+ channel dysfunction is now known to be the basis for several neurological and muscle disorders such as migraine, ataxia, and periodic paralysis. In contrast to other types of genetic diseases, Ca2+ channelopathies can be studied with precision by electrophysiological methods, and in some cases, the results have been highly rewarding with a biophysical phenotype that correlates with the ultimate clinical phenotype. This review outlines recent advances in genetic, molecular, and pathophysiological aspects of human Ca2+ channelopathies.
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Affiliation(s)
- Ricardo Felix
- Department of Cell Biology, Center for Research and Advanced Studies, National Polytechnic Institute (Cinvestav-IPN), Mexico City, Mexico.
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132
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Waeber C. Targeting neuronal hyperexcitability for antimigraine drug development. FUTURE NEUROLOGY 2007. [DOI: 10.2217/14796708.2.2.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Migraine is among the most prevalent neurological disorders worldwide, afflicting up to 16% of the population. Because it mostly affects patients between the most productive ages of 25 and 50 years, migraine costs employers more than US$13 billion per year in reduced productivity and missed days. It is therefore important to prevent and treat migraine attacks. Triptans were introduced in the early 1990s and effectively alleviate symptoms in most patients. Their success was based on the existence of the operational hypothesis implicating the trigemino-vascular system. Prophylactic medications have been available since beta-blockers, followed by agents belonging to other therapeutic classes. Most of them were found serendipitously to be effective. However, progress in the development of preventative agents has been hampered by the lack of animal models mimicking the early events of migraine pathophysiology. This review will examine how a recent theory on the origin of migraine attacks is likely to lead to the development of new animal models.
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Affiliation(s)
- Christian Waeber
- Massachusetts General Hospital, Department of Radiology, CNY149 Room 6403, 149 13th Street, Charlestown, MA 02129, USA
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133
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Abstract
Biomarkers are physical signs or laboratory measurements that occur in association with a pathological process and have putative diagnostic and/or prognostic utility. In migraine, clinical, radiological, and biochemical biomarkers might be helpful to improve diagnosis, get insight in pathophysiology, and facilitate treatment choices. Genetic biomarkers are defined as genetic variations (mutations or polymorphisms) that can predict disease susceptibility, disease outcome, or treatment response. As yet, only a few genetic biomarkers for migraine are available. Mutations in 3 different genes responsible for familial hemiplegic migraine, a monogenetic subtype of migraine with aura, and the MTHFR C677T polymorphism in common forms of migraine are clear examples. Many positive findings from linkage studies and association studies in common forms of migraine have not been replicated, and are therefore of less clinical use. In this review, we will discuss genetic biomarkers in migraine.
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Affiliation(s)
- Boukje De Vries
- Department of Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands
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134
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Luvisetto S, Marinelli S, Panasiti MS, D'Amato FR, Fletcher CF, Pavone F, Pietrobon D. Pain sensitivity in mice lacking the Ca(v)2.1alpha1 subunit of P/Q-type Ca2+ channels. Neuroscience 2006; 142:823-32. [PMID: 16890369 DOI: 10.1016/j.neuroscience.2006.06.049] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Revised: 05/29/2006] [Accepted: 06/22/2006] [Indexed: 11/26/2022]
Abstract
The role of voltage-gated Ca(2+) (Ca(V)) channels in pain mechanisms has been the object of intense investigation using pharmacological approaches and, more recently, using mutant mouse models lacking the Ca(V)alpha(l) pore-forming subunit of N-, R- and T-type channels. The role of P/Q-type channels in nociception and pain transmission has been investigated by pharmacological approaches but remains to be fully elucidated. To address this issue, we have analyzed pain-related behavioral responses of null mutant mice for the Ca(V)2.1alpha(1) subunit of P/Q-type channels. Homozygous null mutant Ca(V)2.1alpha(1)-/- mice developed dystonia at 10-12 days after birth and did not survive past weaning. Tested at ages where motor deficit was either absent or very mild, Ca(V)2.1alpha(1)-/- mice showed reduced tail withdrawal latencies in the tail-flick test and reduced abdominal writhes in the acetic acid writhing test. Adult heterozygous Ca(V)2.1alpha(1)+/- mice did not show motor deficits in the rotarod and activity cage tests and did not show alterations in pain responses in the tail-flick test and the acetic acid writhing test. Strikingly, they showed a reduced licking response during the second phase of formalin-induced inflammatory pain and a reduced mechanical allodynia in the chronic constriction injury model of neuropathic pain. Our findings show that P/Q-type channels play an antinociceptive role in sensitivity to non-injurious noxious thermal stimuli and a pronociceptive role in inflammatory and neuropathic pain states, pointing to an important role of Ca(V)2.1 channels in central sensitization.
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Affiliation(s)
- S Luvisetto
- CNR Institute of Neuroscience, Section of Psychobiology and Psychopharmacology, Via del Fosso di Fiorano 64, 00143 Roma, Italy.
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135
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Abstract
Neuronal-glial circuits underlie integrative processes in the nervous system. Function of glial syncytium is, to a very large extent, regulated by the intracellular calcium signaling system. Glial calcium signals are triggered by activation of multiple receptors, expressed in glial membrane, which regulate both Ca2+ entry and Ca2+ release from the endoplasmic reticulum. The endoplasmic reticulum also endows glial cells with intracellular excitable media, which is able to produce and maintain long-ranging signaling in a form of propagating Ca2+ waves. In pathological conditions, calcium signals regulate glial response to injury, which might have both protective and detrimental effects on the nervous tissue.
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136
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de Theije-Kors E, Haan J. Hemiplegic and Basilar-type Migraine: Epidemiology, Genetics, and Mechanisms. ACTA ACUST UNITED AC 2006. [DOI: 10.1111/j.1743-5013.2006.00036.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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137
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Invited Lectures : Overviews Purinergic signalling: past, present and future. Purinergic Signal 2006; 2:1-324. [PMID: 18404494 PMCID: PMC2096525 DOI: 10.1007/s11302-006-9006-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2006] [Indexed: 12/11/2022] Open
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138
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Gupta VK. Migrainous scintillating scotoma and headache is ocular in origin: A new hypothesis. Med Hypotheses 2005; 66:454-60. [PMID: 16356654 DOI: 10.1016/j.mehy.2005.11.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2005] [Accepted: 11/03/2005] [Indexed: 11/24/2022]
Abstract
Brain neuronal dysfunction has been implicated in pathogenesis of migraine but direct evidence is lacking. Scintillating scotoma of migraine is generally believed to originate at the visual cortex. While cortical spreading depression is a relatively late physiological alteration in migraine, its protective role in neuronal ischaemia is increasingly being recognized. Atenolol, nadolol, or verapamil prevent migraine but do not readily cross the blood-brain barrier or critically influence any brain or peripheral neuronal function. Typical migraine headache, aura, or scintillating scotoma has not been reported following enucleation or evisceration of the eye. In humans, pain and temperature fibres from only the ophthalmic division of the trigeminal nerve reach the upper cervical spinal segments. Pain in migraine attacks including occipital and nuchal discomfort reflects selective involvement of the ophthalmic nerve. Photophobia is largely a retinal reflex involving the ophthalmic division of the trigeminal nerve. Key clinical features of the migrainous scintillating scotoma are consistent with retinal origin. Spreading depression in the retina is well-established. A subtle regional ocular sympathetic deficit prevails in migraine patients and possibly impairs regulation of intraocular choroidal blood volume and intraocular pressure. Several first-line migraine prophylactic agents lower the intraocular pressure. The neuro-ophthalmological basis for a monocular origin of migrainous scintillating scotomata due to mechanical deformation of the posterior segment of the corneo-scleral envelope consequent to choroidal venous congestion and rise in intraocular pressure is presented. Study of distribution and displaceability of the migrainous scintillating scotoma can settle its site of origin. Headache of migraine possibly arises from a similar mechanical deformation of the anterior eye segment followed by antidromic discharge in the trigeminovascular system. Lateralizing negative deficits such as homonymous hemianopia probably reflect vasospastic complications of migraine. A rational explanation for the most characteristic clinical features of migraine and a new template to elucidate the pharmacological basis of anti-migraine drugs is offered.
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Affiliation(s)
- Vinod Kumar Gupta
- Dubai Police Medical Services, P.O. Box 12005, Dubai, United Arab Emirates.
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Striessnig J. Pathophysiology of migraine headache: Insight from pharmacology and genetics. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.ddmec.2005.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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140
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Chen SC. Epilepsy and migraine: The dopamine hypotheses. Med Hypotheses 2005; 66:466-72. [PMID: 16298497 DOI: 10.1016/j.mehy.2005.09.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Accepted: 09/27/2005] [Indexed: 11/16/2022]
Abstract
Migraine and epilepsy are both chronic recurrent disorders with paroxysmal attacks. They also share some similar risk factors, symptoms, and preventive medications. Dopamine has long been postulated to be involved in the pathophysiology of migraine and epileptogenesis, by many supporting evidences. However, the role of dopamine is still controversial till now. A lack of a comprehensive hypothetical model may be one of the reasons. "Dopamine hypothesis" is not a new term, but it is proposed to explain the pathophysiology and the associated phenomena of these disorders. The hypotheses suggest that, in migraine, there is a low dopamine tone, while there is a high state of dopamine in generalized epilepsy. But the periodic attacks of headaches and seizures maybe both due to a fall in dopamine activity. Dopamine therefore plays a key role in the linkage of neuroendocrine, autonomic system and neuronal activity. Dopamine agonist is also implied in prophylaxis and neuroprotection in both disorders.
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Affiliation(s)
- Shih-Cheng Chen
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan, ROC.
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Pietrobon D. Function and dysfunction of synaptic calcium channels: insights from mouse models. Curr Opin Neurobiol 2005; 15:257-65. [PMID: 15922581 DOI: 10.1016/j.conb.2005.05.010] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Accepted: 05/06/2005] [Indexed: 11/26/2022]
Abstract
In the past few years several spontaneous or engineered mouse models with mutations in Ca2+ channel genes have become available, providing a powerful approach to defining Ca2+ channel function in vivo. There have been recent advances in outlining the phenotypes and in the functional analysis of mouse models with mutations in genes encoding the pore-forming subunits of Ca(V)2.1 (P/Q-type), Ca(V)2.2 (N-type) and Ca(V)2.3 (R-type) Ca2+ channels, the channels involved in controlling neurotransmitter release at mammalian synapses. These data indicate that Ca(V)2.1 channels have a dominant and efficient specific role in initiating fast synaptic transmission at central excitatory synapses in vivo, and suggest that the Ca(V)2.1 channelopathies are primarily synaptic diseases. The different disorders probably arise from disruption of neurotransmission in specific brain regions: the cortex in the case of migraine, the thalamus in the case of absence epilepsy and the cerebellum in the case of ataxia.
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Affiliation(s)
- Daniela Pietrobon
- Department of Biomedical Sciences, University of Padova, Viale le G. Colombo 3, 35121 Padova, Italy.
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