Insulin- and glucagon-independent effects of calcitonin gene-related peptide in the conscious dog

Alterations in metabolic flux in migraine and the translational relevance

BACKGROUND

Migraine is a highly prevalent disorder with significant economical and personal burden. Despite the development of effective therapeutics, the causes which precipitate migraine attacks remain elusive. Clinical studies have highlighted altered metabolic flux and mitochondrial function in patients. In vivo animal experiments can allude to the metabolic mechanisms which may underlie migraine susceptibility. Understanding the translational relevance of these studies are important to identifying triggers, biomarkers and therapeutic targets in migraine.

MAIN BODY

Functional imaging studies have suggested that migraineurs feature metabolic syndrome, exhibiting hallmark features including upregulated oxidative phosphorylation yet depleted available free energy. Glucose hypometabolism is also evident in migraine patients and can lead to altered neuronal hyperexcitability such as the incidence of cortical spreading depression (CSD). The association between obesity and increased risk, frequency and worse prognosis of migraine also highlights lipid dysregulation in migraine pathology. Calcitonin gene related peptide (CGRP) has demonstrated an important role in sensitisation and nociception in headache, however its role in metabolic regulation in connection with migraine has not been thoroughly explored. Whether impaired metabolic function leads to increased release of peptides such as CGRP or excessive nociception leads to altered flux is yet unknown.

CONCLUSION

Migraine susceptibility may be underpinned by impaired metabolism resulting in depleted energy stores and altered neuronal function. This review discusses both clinical and in vivo studies which provide evidence of altered metabolic flux which contribute toward pathophysiology. It also reviews the translational relevance of animal studies in identifying targets of biomarker or therapeutic development.

Role of calcitonin gene-related peptide in energy metabolism

PURPOSE

Calcitonin gene-related peptide (CGRP) is a neuropeptide produced by alternative tissue-specific splicing of the primary transcript of the CALC genes. CGRP is widely distributed in the central and peripheral nervous system, as well as in several organs and tissues. The presence of CGRP in the liver and brown and white adipose tissue suggests an effect of this neuropeptide on regulation of energy homeostasis.

METHODS

In this review, we summarize the current knowledge of the effect of CGRP on the control of energy metabolism, primarily focusing on food intake, thermoregulation and lipid metabolism in adipose tissue, liver and muscle.

RESULTS

CGRP induces anorexia, stimulating anorexigenic neuropeptide and/or inhibiting orexigenic neuropeptide expression, through cAMP/PKA pathway activation. CGRP also induces energy expenditure, increasing the skin temperature and brown adipose tissue thermogenesis. It has been also suggested that information related to peripheral lipid stores may be conveyed to the brain via CGRP-sensory innervation from adipose tissue. More recently, it was demonstrated that mice lacking αCGRP are protected from obesity induced by high-fat diet and that CGRP regulates the content of lipid in liver, muscle and adipose tissue.

CONCLUSIONS

It is unclear the receptor responsible by CGRP effects, as well as whether this neuropeptide acts directly or indirectly in liver, muscle and adipose tissue.

Contra-insular effect of calcitonin on glucose metabolism

We studied the effects of Russian preparation of porcine calcitonin (Calcitrinum, 1 U/100 g) on the level of glucose and total calcium, glycogen concentration in the liver, and glucose consumption by the muscle and adipose tissues in vivo and in vitro. The basal level of insulin and secretion of insulin in the dynamics of glucose tolerance test were studied after treatment with calcitonin. In addition to hypocalcemic effect, this substance produced significant hyperglycemic effects, decreased glycogen amount in the liver, inhibited insulin-induced glucose consumption by muscular and adipose tissues in vivo and in vitro, slowed down insulin secretion during glucose load, and impaired glucose tolerance. Thus, calcitonin had contra-insular effects on glucose metabolism.

Diabetes mellitus influences the degree of colocalization of calcitonin gene-related peptide with insulin and somatostatin in the rat pancreas

OBJECTIVES

Although calcitonin-gene related peptide (CGRP) (C162H262N50O50S2) has been shown to be present in pancreatic islet cells, no data have been reported on the pattern of its distribution in the islets of Langerhans of diabetic rats.

METHODS

The present study used immunohistochemical and immunofluorescence techniques to examine the pattern of distribution of CGRP-like immunoreactive (CGRP-LIR) cells and nerves in the pancreata of rats with streptozotocin-induced diabetes. The effect of CGRP on insulin secretion from rat pancreatic tissue fragments was also investigated using a radioimmunoassay technique.

RESULTS

Numerous CGRP-LIR cells were observed in both the peripheral and central regions of the islets of Langerhans of normal pancreata where they colocalized with large and small subsets of insulin-LIR and somatostatin-LIR cells, respectively. By contrast, the islets of diabetic rat pancreata contained significantly (P < 0.0001) fewer CGRP-LIR cells compared with normal rats. In diabetic rat pancreata, CGRP was colocalized with larger and smaller subsets of somatostatin-LIR and insulin-LIR cells, respectively. CGRP-LIR nerve fibers were discerned in the perivascular and periacinar regions of the pancreata of both normal and diabetic rats. CGRP (10 M) induced a significant (P < 0.02) increase in insulin secretion from the pancreas of normal rat.

CONCLUSION

CGRP is colocalized with insulin and somatostatin in the pancreata of normal and diabetic rats and may play an important role in the humoral and neural regulation of the endocrine pancreas.