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Guerzoni S, Castro FL, Brovia D, Baraldi C, Pani L. Evaluation of the risk of hypertension in patients treated with anti-CGRP monoclonal antibodies in a real-life study. Neurol Sci 2024; 45:1661-1668. [PMID: 37926748 DOI: 10.1007/s10072-023-07167-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To explore the rate of hypertension incoming in patients treated with monoclonal antibodies against the calcitonin gene-related peptide. BACKGROUND The monoclonal antibodies blocking the calcitonin gene-related peptide are unquestionable effective in the prevention of migraine. Despite this, the development of hypertension has been detected in some patients. METHODS This was a retrospective study conducted at the University Hospital of Modena. Patients were visited quarterly up to 1 year. RESULTS Globally, no significant increase in the blood pressure was detected. The 5.7% of the patients developed a significant increase in their blood pressure. In particular, patients with a pre-existing hypertension were more likely to have a significant increase in the blood pressure. CONCLUSION The risk of developing hypertension during a treatment with anti-calcitonin gene-related peptide monoclonal antibodies seems low. Anyway, patients with a pre-existing hypertension should be cautiously monitored because they are more likely to develop hypertension.
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Affiliation(s)
- Simona Guerzoni
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics; Department of Specialist Medicines, AOU Policlinico di Modena, Modena, Italy
| | - Flavia Lo Castro
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics; Department of Specialist Medicines, AOU Policlinico di Modena, Modena, Italy.
| | - Daria Brovia
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics; Department of Specialist Medicines, AOU Policlinico di Modena, Modena, Italy
| | - Carlo Baraldi
- Pharmacology Unit; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Pani
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics; Department of Specialist Medicines, AOU Policlinico di Modena, Modena, Italy
- Pharmacology Unit; Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Department of Psychiatry and Behavioral Sciences, University of Miami, Coral Gables, USA
- VeraSci, Durham, USA
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Sohn I, Sheykhzade M, Edvinsson L, Sams A. The effects of CGRP in vascular tissue - Classical vasodilation, shadowed effects and systemic dilemmas. Eur J Pharmacol 2020; 881:173205. [PMID: 32442540 DOI: 10.1016/j.ejphar.2020.173205] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/29/2020] [Accepted: 05/14/2020] [Indexed: 02/02/2023]
Abstract
Vascular tissue consists of endothelial cells, vasoactive smooth muscle cells and perivascular nerves. The perivascular sensory neuropeptide CGRP has demonstrated potent vasodilatory effects in any arterial vasculature examined so far, and a local protective CGRP-circuit of sensory nerve terminal CGRP release and smooth muscle cell CGRP action is evident. The significant vasodilatory effect has shadowed multiple other effects of CGRP in the vascular tissue and we therefore thoroughly review vascular actions of CGRP on endothelial cells, vascular smooth muscle cells and perivascular nerve terminals. The actions beyond vasodilation includes neuronal re-uptake and neuromodulation, angiogenic, proliferative and antiproliferative, pro- and anti-inflammatory actions which vary depending on the target cell and anatomical location. In addition to the classical perivascular nerve-smooth muscle CGRP circuit, we review existing evidence for a shadowed endothelial autocrine pathway for CGRP. Finally, we discuss the impact of local and systemic actions of CGRP in vascular regulation and protection from hypertensive and ischemic heart conditions with special focus on therapeutic CGRP agonists and antagonists.
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Affiliation(s)
- Iben Sohn
- Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet Glostrup, Nordstjernevej 42, DK-2600, Glostrup, Denmark
| | - Majid Sheykhzade
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Universitetsparken 2, DK-2100, Copenhagen Oe, Denmark
| | - Lars Edvinsson
- Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet Glostrup, Nordstjernevej 42, DK-2600, Glostrup, Denmark; Department of Clinical Sciences, Division of Experimental Vascular Research, Lund University, Lund, Sweden
| | - Anette Sams
- Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet Glostrup, Nordstjernevej 42, DK-2600, Glostrup, Denmark.
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Yorek MS, Obrosov A, Lu B, Gerard C, Kardon RH, Yorek MA. Effect of Inhibition or Deletion of Neutral Endopeptidase on Neuropathic Endpoints in High Fat Fed/Low Dose Streptozotocin-Treated Mice. J Neuropathol Exp Neurol 2016; 75:1072-1080. [PMID: 27634964 PMCID: PMC7714044 DOI: 10.1093/jnen/nlw083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Previously we demonstrated that a vasopeptidase inhibitor of angiotensin converting enzyme and neutral endopeptidase (NEP), a protease that degrades vaso- and neuro-active peptides, improves neural function in diabetic rodent models. The purpose of this study was to determine whether inhibition or deletion of NEP provides protection from neuropathy caused by diabetes with an emphasis on morphology of corneal nerves as a primary endpoint. Diabetes, modeling type 2, was induced in C57Bl/6J and NEP deficient mice through a combination of a high fat diet and streptozotocin. To inhibit NEP activity, diabetic C57Bl/6J mice were treated with candoxatril using a prevention or intervention protocol. Twelve weeks after the induction of diabetes in C57Bl/6J mice, the existence of diabetic neuropathy was determined through multiple endpoints including decrease in corneal nerves in the epithelium and sub-epithelium layer. Treatment of diabetic C57Bl/6J mice with candoxatril improved diabetic peripheral neuropathy and protected corneal nerve morphology with the prevention protocol being more efficacious than intervention. Unlike C57Bl/6J, mice deficient in NEP were protected from the development of neuropathologic alterations and loss of corneal nerves upon induction of diabetes. These studies suggest that NEP contributes to the development of diabetic neuropathy and may be a treatable target.
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Affiliation(s)
- Matthew S Yorek
- From the Department of Veterans Affairs Iowa City Health Care System, Iowa City, IA(MSY, RHK, MAY), Department of Internal Medicine, University of Iowa, Iowa City, IA(AO, MAY), Department of Pediatrics and Medicine, Harvard Medical School, Ina Sue Perlmutter Laboratory, Children's Hospital, Boston, MA(BL), Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA(RHK), Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, IA(RHK, MAY) and Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA(MAY)
| | - Alexander Obrosov
- From the Department of Veterans Affairs Iowa City Health Care System, Iowa City, IA(MSY, RHK, MAY), Department of Internal Medicine, University of Iowa, Iowa City, IA(AO, MAY), Department of Pediatrics and Medicine, Harvard Medical School, Ina Sue Perlmutter Laboratory, Children's Hospital, Boston, MA(BL), Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA(RHK), Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, IA(RHK, MAY) and Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA(MAY)
| | - Bao Lu
- From the Department of Veterans Affairs Iowa City Health Care System, Iowa City, IA(MSY, RHK, MAY), Department of Internal Medicine, University of Iowa, Iowa City, IA(AO, MAY), Department of Pediatrics and Medicine, Harvard Medical School, Ina Sue Perlmutter Laboratory, Children's Hospital, Boston, MA(BL), Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA(RHK), Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, IA(RHK, MAY) and Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA(MAY)
| | - Craig Gerard
- From the Department of Veterans Affairs Iowa City Health Care System, Iowa City, IA(MSY, RHK, MAY), Department of Internal Medicine, University of Iowa, Iowa City, IA(AO, MAY), Department of Pediatrics and Medicine, Harvard Medical School, Ina Sue Perlmutter Laboratory, Children's Hospital, Boston, MA(BL), Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA(RHK), Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, IA(RHK, MAY) and Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA(MAY)
| | - Randy H Kardon
- From the Department of Veterans Affairs Iowa City Health Care System, Iowa City, IA(MSY, RHK, MAY), Department of Internal Medicine, University of Iowa, Iowa City, IA(AO, MAY), Department of Pediatrics and Medicine, Harvard Medical School, Ina Sue Perlmutter Laboratory, Children's Hospital, Boston, MA(BL), Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA(RHK), Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, IA(RHK, MAY) and Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA(MAY)
| | - Mark A Yorek
- From the Department of Veterans Affairs Iowa City Health Care System, Iowa City, IA(MSY, RHK, MAY), Department of Internal Medicine, University of Iowa, Iowa City, IA(AO, MAY), Department of Pediatrics and Medicine, Harvard Medical School, Ina Sue Perlmutter Laboratory, Children's Hospital, Boston, MA(BL), Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA(RHK), Veterans Affairs Center for the Prevention and Treatment of Visual Loss, Iowa City, IA(RHK, MAY) and Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IA(MAY)
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McNeish AJ, Roux BT, Aylett SB, Van Den Brink AM, Cottrell GS. Endosomal proteolysis regulates calcitonin gene-related peptide responses in mesenteric arteries. Br J Pharmacol 2013; 167:1679-90. [PMID: 22881710 DOI: 10.1111/j.1476-5381.2012.02129.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 06/11/2012] [Accepted: 06/17/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Calcitonin gene-related peptide (CGRP) is a potent vasodilator, implicated in the pathogenesis of migraine. CGRP activates a receptor complex comprising, calcitonin receptor-like receptor (CLR) and receptor activity-modifying protein 1 (RAMP1). In vitro studies indicate recycling of CLR●RAMP1 is regulated by degradation of CGRP in early endosomes by endothelin-converting enzyme-1 (ECE-1). However, it is not known if ECE-1 regulates the resensitization of CGRP-induced responses in functional arterial tissue. EXPERIMENTAL APPROACH CLR, ECE-1a-d and RAMP1 expression in rat mesenteric artery smooth muscle cells (RMA-SMCs) and mesenteric arteries was analysed by RT-PCR and by immunofluorescence and confocal microscopy. CGRP-induced signalling in cells was examined by measuring cAMP production and ERK activation. CGRP-induced relaxation of arteries was measured by isometric wire myography. ECE-1 was inhibited using the specific inhibitor, SM-19712. KEY RESULTS RMA-SMCs and arteries contained mRNA for CLR, ECE-1a-d and RAMP1. ECE-1 was present in early endosomes of RMA-SMCs and in the smooth muscle layer of arteries. CGRP induced endothelium-independent relaxation of arteries. ECE-1 inhibition had no effect on initial CGRP-induced responses but reduced cAMP generation in RMA-SMCs and vasodilation in mesenteric arteries responses to subsequent CGRP challenges. CONCLUSIONS AND IMPLICATIONS ECE-1 regulated the resensitization of responses to CGRP in RMA-SMCs and mesenteric arteries. CGRP-induced relaxation did not involve endothelium-derived pathways. This is the first report of ECE-1 regulating CGRP responses in SMCs and arteries. ECE-1 inhibitors may attenuate an important vasodilatory pathway, implicated in primary headaches and may represent a new therapeutic approach for the treatment of migraine.
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Affiliation(s)
- A J McNeish
- Reading School of Pharmacy, University of Reading, Whiteknights, Reading, UK
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Carmichael NME, Dostrovsky JO, Charlton MP. Enhanced vascular permeability in rat skin induced by sensory nerve stimulation: evaluation of the time course and appropriate stimulation parameters. Neuroscience 2008; 153:832-41. [PMID: 18420352 DOI: 10.1016/j.neuroscience.2008.02.068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 02/25/2008] [Accepted: 02/29/2008] [Indexed: 11/29/2022]
Abstract
Activation of nociceptors causes them to secrete neuropeptides. The binding of these peptides to receptors on blood vessels causes vasodilation and increased vascular permeability that allows loss of proteins and fluid (plasma extravasation, PE); this contributes to inflammation. This study defines the relationship between electrical activation of nociceptors and PE and evaluates the time course of this response in the skin of rats. We measured the time course and extent of PE by digital imaging of changes in skin reflectance caused by leakage of Evans Blue (EB) dye infused in the circulatory system before stimulation. Stimulation of the exclusively sensory saphenous nerve caused the skin to become dark blue within 2 min due to accumulation of EB. While PE is usually measured after 5-15 min of electrical stimulation, we found that stimulation for only 1 min at 4 Hz produced maximum PE. This response was dependent on the number of electrical stimuli at least for 4 Hz and 8 Hz stimulation rates. Since accumulation of EB in the skin is only slowly reversible, to determine the duration of enhanced vascular permeability we administered EB at various times after electrical stimulation of the saphenous nerve. PE was only observed when EB was infused within 5 min of electrical stimulation but could still be observed 50 min after capsaicin (1%, 25 microl) injection into the hind paw. These findings indicate that enhanced vascular permeability evoked by electrical stimulation persists only briefly after release of neuropeptides from nociceptors in the skin. Therefore, treatment of inflammation by blockade of neuropeptide release and receptors may be more effective than treatments aimed at epithelial gaps. We propose, in models of stimulation-induced inflammation, the use of a short stimulus train.
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Affiliation(s)
- N M E Carmichael
- University of Toronto, Department of Physiology, Toronto, Ontario, Canada.
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