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Genetic analyses identify pleiotropy and causality for blood proteins and highlight Wnt/β-catenin signalling in migraine. Nat Commun 2022; 13:2593. [PMID: 35546551 PMCID: PMC9095680 DOI: 10.1038/s41467-022-30184-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
Migraine is a common complex disorder with a significant polygenic SNP heritability (\documentclass[12pt]{minimal}
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\begin{document}$${h}_{{SNP}}^{2}$$\end{document}hSNP2). Here we utilise genome-wide association study (GWAS) summary statistics to study pleiotropy between blood proteins and migraine under the polygenic model. We estimate \documentclass[12pt]{minimal}
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\begin{document}$${h}_{{SNP}}^{2}$$\end{document}hSNP2 for 4625 blood protein GWASs and identify 325 unique proteins with a significant \documentclass[12pt]{minimal}
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\begin{document}$${h}_{{SNP}}^{2}$$\end{document}hSNP2 for use in subsequent genetic analyses. Pleiotropy analyses link 58 blood proteins to migraine risk at genome-wide, gene and/or single-nucleotide polymorphism levels—suggesting shared genetic influences or causal relationships. Notably, the identified proteins are largely distinct from migraine GWAS loci. We show that higher levels of DKK1 and PDGFB, and lower levels of FARS2, GSTA4 and CHIC2 proteins have a significant causal effect on migraine. The risk-increasing effect of DKK1 is particularly interesting—indicating a role for downregulation of β-catenin-dependent Wnt signalling in migraine risk, suggesting Wnt activators that restore Wnt/β-catenin signalling in brain could represent therapeutic tools against migraine. Understanding of the causes and treatment of migraine is incomplete. Here, the authors detect pleiotropic genetic effects and causal relationships between migraine and 58 proteins that are largely distinct from migraine-associated loci identified by GWAS.
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Liktor-Busa E, Blawn KT, Kellohen KL, Wiese BM, Verkhovsky V, Wahl J, Vivek A, Palomino SM, Davis TP, Vanderah TW, Largent-Milnes TM. Functional NHE1 expression is critical to blood brain barrier integrity and sumatriptan blood to brain uptake. PLoS One 2020; 15:e0227463. [PMID: 32469979 PMCID: PMC7259629 DOI: 10.1371/journal.pone.0227463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/04/2020] [Indexed: 12/31/2022] Open
Abstract
Disruption of blood-brain barrier integrity and dramatic failure of brain ion homeostasis including fluctuations of pH occurs during cortical spreading depression (CSD) events associated with several neurological disorders, including migraine with aura, traumatic brain injury and stroke. NHE1 is the primary regulator of pH in the central nervous system. The goal of the current study was to investigate the role of sodium-hydrogen exchanger type 1 (NHE1) in blood brain barrier (BBB) integrity during CSD events and the contributions of this antiporter on xenobiotic uptake. Using immortalized cell lines, pharmacologic inhibition and genetic knockdown of NHE1 mitigated the paracellular uptake of radiolabeled sucrose implicating functional NHE1 in BBB maintenance. In contrast, loss of functional NHE1 in endothelial cells facilitated uptake of the anti-migraine therapeutic, sumatriptan. In female rats, cortical KCl but not aCSF selectively reduced total expression of NHE1 in cortex and PAG but increased expression in trigeminal ganglia; no changes were seen in trigeminal nucleus caudalis. Thus, in vitro observations may have a significance in vivo to increase brain sumatriptan levels. Pharmacological inhibition of NHE1 prior to cortical manipulations enhanced the efficacy of sumatriptan at early time-points but induced facial sensitivity alone. Overall, our results suggest that dysregulation of NHE1 contributes to breaches in BBB integrity, drug penetrance, and the behavioral sensitivity to the antimigraine agent, sumatriptan.
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Affiliation(s)
- Erika Liktor-Busa
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Kiera T. Blawn
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Kathryn L. Kellohen
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Beth M. Wiese
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Vani Verkhovsky
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Jared Wahl
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Anjali Vivek
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Seph M. Palomino
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Thomas P. Davis
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Todd W. Vanderah
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
| | - Tally M. Largent-Milnes
- Department of Pharmacology, University of Arizona, Tucson, Arizona, United States of America
- * E-mail:
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Chua AL, Grosberg BM, Evans RW. Status Migrainosus in Children and Adults. Headache 2019; 59:1611-1623. [DOI: 10.1111/head.13676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Abigail L. Chua
- Hartford Healthcare Headache Center University of Connecticut School of Medicine West Hartford CT USA
| | - Brian M. Grosberg
- Hartford Healthcare Headache Center University of Connecticut School of Medicine West Hartford CT USA
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Udelsmann A, Saccomani P, Dreyer E, da Costa ALC. Treatment of status migrainosus by general anesthesia: a case report. Braz J Anesthesiol 2015; 65:407-10. [PMID: 26323741 DOI: 10.1016/j.bjane.2013.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 09/09/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The status migrainosus is a complication of migraine characterized by severe headache for more than 72h that did not respond to treatment, with risk of stroke and suicide. Researches on treatment are directed to drugs that stimulate GABA receptors; propofol and isoflurane act on sub-GABAa receptors and theoretically could be interesting. The first has been the subject of research in severe migraine. Opioids are employed in pain, and its use in chronic headache is debatable, but these agents are employed in acute cases. The goal is to present a case of refractory status migrainosus in that we decided to break the pain cycle by general anesthesia. CASE REPORT Female patient, aged 50 years, with status migrainosus, in the last five days with visits to the emergency department, medicated parenterally with various agents without result. Without comorbidities, dehydrated, described her pain as "well over 10" in Visual Numeric Scale (VNS). After consulting the literature, and given the apparent severity of the condition, we opted for a general anesthesia: induction with fentanyl, propofol, and vecuronium and maintenance with isoflurane and propofol for two hours. Following the treatment, in the postanesthetic recuperation (PAR), the patient related her pain as VNS 3, and was released after five hours with VNS 2. Subsequently, her preventive treatment was resumed. CONCLUSION Status migrainosus is a rare disabling complication and anesthetics have been the subject of research in its treatment; the option for general anesthesia with agents that stimulate GABA receptors, propofol and isoflurane, in association with fentanyl, proved effective and should encourage new research.
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Affiliation(s)
- Artur Udelsmann
- Departamento de Anestesiologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil.
| | - Priscila Saccomani
- Serviço de Anestesia, Hospital das Clínicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Elisabeth Dreyer
- Hospital das Clínicas, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Udelsmann A, Saccomani P, Dreyer E, Costa ALCD. Tratamento do estado de mal‐enxaquecoso pela anestesia geral: relato de caso. Braz J Anesthesiol 2015; 65:407-10. [DOI: 10.1016/j.bjan.2013.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 09/09/2013] [Indexed: 10/26/2022] Open
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Souillard-Scemama R, Tisserand M, Calvet D, Jumadilova D, Lion S, Turc G, Edjlali M, Mellerio C, Lamy C, Naggara O, Meder JF, Oppenheim C. An update on brain imaging in transient ischemic attack. J Neuroradiol 2015; 42:3-11. [DOI: 10.1016/j.neurad.2014.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 11/15/2014] [Indexed: 10/24/2022]
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Kim YJ, Kwon SU. Recurrent steroid-responsive cerebral vasogenic edema in status migrainosus and persistent aura. Cephalalgia 2014; 35:728-34. [DOI: 10.1177/0333102414553820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 08/14/2014] [Indexed: 11/16/2022]
Abstract
Background Status migrainosus (SM) and persistent aura (PA) without infarction are complications of migraine. Although several patients have been reported to have reversible brain lesions associated with complications of migraine, their nature and pathophysiology remain unclear. Case We report on a 38-year-old male who presented with nine episodes of SM and PA over eight years. Serial neuroimaging studies including brain magnetic resonance imaging (MRI), blood flow single photon emission tomography (SPECT),18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) and11 C-flumazenil PET (FMZ-PET) demonstrated cerebral vasogenic edema (CVE) with hypoperfusion and hypometabolism in the area, anatomically corresponding to the area with PA. SM and PA were effectively controlled by corticosteroid therapy. Follow-up MRI revealed complete reversibility of the CVE, which was supported by normal FMZ-PET and FDG-PET findings. Conclusion We have described a patient with transient brain lesions associated with complications of migraine who was diagnosed with fully reversible and steroid responsive CVE.
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Affiliation(s)
- Yeon-Jung Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea
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Plessas I, Volk H, Kenny P. Migraine-like Episodic Pain Behavior in a Dog: Can Dogs Suffer from Migraines? J Vet Intern Med 2013; 27:1034-40. [DOI: 10.1111/jvim.12167] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 05/13/2013] [Accepted: 07/16/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- I.N. Plessas
- Department of Clinical Sciences and Services; Royal Veterinary College; Hatfield UK
| | - H.A. Volk
- Department of Clinical Sciences and Services; Royal Veterinary College; Hatfield UK
| | - P.J. Kenny
- Department of Clinical Sciences and Services; Royal Veterinary College; Hatfield UK
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Eidlitz-Markus T, Zeharia A, Haimi-Cohen Y, Konen O. MRI white matter lesions in pediatric migraine. Cephalalgia 2013; 33:906-13. [PMID: 23575818 DOI: 10.1177/0333102413480955] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Studies have reported an association between migraine and white matter hyperintensities on T2-weighted brain magnetic resonance imaging (MRI) in adults. The aim of the present study was to evaluate white matter MRI brain findings in pediatric patients with migraine. METHODS The medical files and imaging scans of all 194 patients who underwent brain MRI at the headache clinic of a tertiary medical center in 2008-2011 were reviewed. RESULTS Mean age was 10.9 ± 3.5 years. Migraine was diagnosed in 131 patients and other disorders in 63. In the migraine group, findings on physical and laboratory examinations were within normal range. White matter lesions were identified on MRI scan in 14 children with migraine (10.6%) and none of the children with other disorders ( P = 0.006). In 13/14 patients, the lesions were focal with a variable distribution; in the remaining patient, confluent periventricular hyperintensities were documented. CONCLUSIONS In a headache clinic of a tertiary pediatric medical center, white matter lesions are found in about 10% of pediatric patients with migraine.
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Affiliation(s)
- Tal Eidlitz-Markus
- Pediatric Headache Clinic, Ambulatory Day Care Hospitalization Unit, Schneider Children's Medical Center of Israel, Israel.
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Asghar SJ, Milesi-Hallé A, Kaushik C, Glasier C, Sharp GB. Variable manifestations of familial hemiplegic migraine associated with reversible cerebral edema in children. Pediatr Neurol 2012; 47:201-4. [PMID: 22883286 DOI: 10.1016/j.pediatrneurol.2012.05.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 05/09/2012] [Indexed: 11/16/2022]
Abstract
Three children with familial hemiplegic migraine presented with right-sided weakness, speech difficulty, altered mental status, and gait abnormalities. These persistent aura signs were accompanied by left-sided slowing and cerebral dysfunction, documented by electroencephalograms. Cranial magnetic resonance imaging revealed cortical edema restricted to the left cerebral hemisphere. Follow-up electroencephalogram and imaging studies produced normal results 1-4 months afterward. However, cognitive changes persisted. Genetic testing demonstrated variable results: one child manifested a CACNA1A mutation compatible with familial hemiplegic migraine type 1, whereas another demonstrated an ATP1A2 sequence alteration. No known mutations were evident in the third child, with minor head trauma thought to precipitate the familial hemiplegic migraine. These findings demonstrate the variable clinical and genetic heterogeneity of childhood familial hemiplegic migraine.
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Affiliation(s)
- Sheila J Asghar
- Section of Pediatric Neurology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72202, USA.
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Goodwin D. Transient complete homonymous hemianopia associated with migraine. ACTA ACUST UNITED AC 2011; 82:298-305. [PMID: 21524601 DOI: 10.1016/j.optm.2010.12.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 10/31/2010] [Accepted: 12/28/2010] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Because of the transient and rare nature, objective visual and neuroimaging evaluation during an acute, spontaneous attack of a migrainous aura causing a complete homonymous hemianopia has not been reported. CASE REPORT A healthy 27-year-old white woman with a history of typical aura with migraine presented during an episode of no light perception in the right hemifield of both eyes. Ophthalmic testing and neuroimaging were unremarkable. The visual field defect started to resolve 1 hour after initial symptoms, and significant improvement was seen after 4 hours. One year later, the patient had no visual field defects and had not experienced another episode of homonymous hemianopia. DISCUSSION More than one third of migrainous patients experience visual symptoms. Typical aura with migraine is diagnosed usually by history. Laboratory testing and neuroimaging are necessary if an alternative cause is suspected, i.e., the aura begins after age 40 years, negative features are predominant, or the aura is very short or prolonged. Correct diagnosis is critical, because conditions that mimic migrainous aura have potentially devastating consequences. Migraine with aura patients may have persistent visual field defects and are at an increased risk for stroke compared with nonmigraine patients. This case improves our knowledge of the nature of a transient homonymous hemianopia associated with migraine.
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Affiliation(s)
- Denise Goodwin
- Pacific University College of Optometry, Forest Grove, OR 97116, USA.
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Belcastro V, Striano P, Pierguidi L, Calabresi P, Tambasco N. Ictal Epileptic Headache Mimicking Status Migrainosus: EEG and DWI-MRI Findings. Headache 2011; 51:160-2. [DOI: 10.1111/j.1526-4610.2010.01709.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Aphasic and visual aura with increased vasogenic leakage: An atypical migrainosus status. J Neurol Sci 2009; 285:227-9. [DOI: 10.1016/j.jns.2009.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Revised: 05/27/2009] [Accepted: 06/01/2009] [Indexed: 11/21/2022]
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