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Al-Kuraishy HM, Al-Gareeb AI, Alexiou A, Mukerjee N, Al-Hamash SMJ, Al-Maiahy TJ, Batiha GES. 5-HT/CGRP pathway and Sumatriptan role in Covid-19. Biotechnol Genet Eng Rev 2022:1-26. [PMID: 36042570 DOI: 10.1080/02648725.2022.2108996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 07/21/2022] [Indexed: 12/27/2022]
Abstract
Coronavirus disease 2019 (Covid-19) is a pandemic caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). In Covid-19, there is uncontrolled activation of immune cells with a massive release of pro-inflammatory cytokines and the development of cytokine storm. These inflammatory changes induce impairment of different organ functions, including the central nervous system (CNS), leading to acute brain injury and substantial changes in the neurotransmitters, including serotonin (5-HT) and calcitonin gene-related peptide (CGRP), which have immunomodulatory properties through modulation of central and peripheral immune responses. In Covid-19, 5-HT neurotransmitters and CGRP could contribute to abnormal and atypical vascular reactivity. Sumatriptan is a pre-synaptic 5-HT (5-HT1D and 5-HT1B) agonist and inhibits the release of CGRP. Both 5-HT and CGRP seem to be augmented in Covid-19 due to underlying activation of inflammatory signaling pathways and hyperinflammation. In virtue of its anti-inflammatory and antioxidant properties with inhibition release of 5-HT and CGRP, Sumatriptan may reduce Covid-19 hyperinflammation. Therefore, Sumatriptan might be a novel potential therapeutic strategy in managing Covid-19. In conclusion, Sumatriptan could be an effective therapeutic strategy in managing Covid-19 through modulation of 5-HT neurotransmitters and inhibiting CGRP.
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Affiliation(s)
- Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Medicine, College of Medicine, AL-Mustansiriyah University, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Medicine, College of Medicine, AL-Mustansiriyah University, Baghdad, Iraq
| | - Athanasios Alexiou
- Department of Science and Engineering, Novel Global Community Educational Foundation, Hebersham, NSW, Australia
- AFNP Med, Wien, Austria
| | - Nobendu Mukerjee
- Department of Microbiology, Ramakrishna Mission Vivekananda Centenary College, Kolkata, India
- Department of Health Sciences, Novel Global Community Educational Foundation, Hebersham, NSW, Australia
| | | | - Thabat J Al-Maiahy
- Department of Gynecology and Obstetrics, College of Medicine, Al-Mustansiriyah University, Baghdad, Iraq
| | - Gaber El-Saber Batiha
- Department of Pharmacology and Therapeutics, Faculty of Veterinary Medicine, Damanhour University, Damanhour, Egypt
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Olofsson IA, Falkenberg K, Olesen J, Hansen TF. Headache provocation by nitric oxide in men who have never experienced a headache. Cephalalgia 2021; 42:598-607. [PMID: 34875880 PMCID: PMC9109242 DOI: 10.1177/03331024211060002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction In the general population 4% have never experienced a headache. Freedom from headache could be due to distinctive protective mechanisms or a lack of environmental risk factors for headache. Isosorbide-5-mononitrate is an organic nitrate which in the body is metabolised to nitric oxide. The nitric oxide pathway plays a crucial role in the primary headaches. We hypothesized that people who are free from headache are protected by distinctive mechanisms in the nitric oxide pathway. Methods We performed an observer blinded case-control study using nitric oxide to provoke a headache. 32 headache free male participants and 26 randomly selected male controls received 60 mg Isosorbide-5-mononitrate orally on the study day. Participants fill out a headache diary with headache intensity and characteristics until 12 hours after administration of Isosorbide-5-mononitrate. Primary endpoint were areas under the curve of headache intensity score. Results All 58 participants completed the study. There was no significant difference in headache incidence, headache intensity score or migraine-like attack between headache free participants and controls. Conclusion We show that men who have never experienced a headache develop a headache when provoked with Isosorbide-5-mononitrate. This indicates that freedom from headache in men is not related to the nitric oxide pathway which is involved in the primary headache disorders.
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Affiliation(s)
- Isa Amalie Olofsson
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Denmark
| | - Katrine Falkenberg
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Denmark
| | - Jes Olesen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Denmark
| | - Thomas Folkmann Hansen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Denmark
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3
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Hijma HJ, Groeneveld GJ. Analgesic drug development: proof-of-mechanism and proof-of-concept in early phase clinical studies. MEDICINE IN DRUG DISCOVERY 2021. [DOI: 10.1016/j.medidd.2021.100083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Zhang G, Liu X, Xu J, Cheng G, Xu J. Comparative analysis of cost-effectiveness between isosorbide-5-mononitrate and isosorbide: a retrospective real-world evaluation. J Comp Eff Res 2020; 9:405-412. [PMID: 32301331 DOI: 10.2217/cer-2019-0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The cost-effectiveness of isosorbide-5-mononitrate (5-ISMN) and isosorbide dinitrate (ISDN) in real-world use in patients with coronary heart disease (CHD; either angina pectoris or myocardial infarction) was retrospectively compared. Method: In this retrospective real-world evaluation, patients with established CHD satisfying the following criteria were selected from information system of two tertiary hospitals in China: with pharmacy claiming for at least one injection of 5-ISMN or ISDN between July 2008 and May 2017; and, CHD patients. By using propensity score matching (PSM), we compared clinical aspects of efficacy, safety, length of hospital stay and cost during hospitalization between 5-ISMN and ISDN group. All data were processed by R statistical package v.2.13.1 (R Foundation for Statistical Computing, Vienna, Austria). Result: Of 5609 patients selected, 4047 received 5-ISMN and 1562 received ISDN. After PSM, we acquired 1555 pairs based on balancing of age, sex, insurance and comorbidities on admission. The frequency (4.2 ± 6.6-times vs 6.5 ± 9.5-times; p < 0.05) and total dosage (47.5 ± 153.4 vs 136.4 ± 261.0 mg; p < 0.05) of sublingual nitroglycerin use decreased and hypotension incidence lowered (8.0 vs 13.0%; p < 0.05) in 5-ISMN group compared with ISDN group. Hospital stay (16.0 ± 11.3 days vs 17.7 ± 13.2; p < 0.05) and hospitalization expenditure ([the ratio of cost in the study to the average hospitalization cost in the city] [odds ratio: 2.5 vs 2.6; p < 0.05]) were reduced in 5-ISMN group as with that of ISDN group. Moreover, the main component of hospitalization cost was medical consumables and medications in both the groups. Conclusion: In the present retrospective real-world evaluation, by using PSM analysis, we found that newer injection agent of 5-ISMN was associated with fewer use of sublingual nitroglycerin, less hypotension incidence, shorter length of hospital stay and less hospitalization expenditure related to its comparator ISDN in patients with established CHD. Further evaluation and clinical experience are need in different circumference for the usage of ISDN.
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Affiliation(s)
- Guimin Zhang
- National Engineering & Technology Research Center of Chirality Pharmaceutical, Linyi, Shandong, China
| | - Xinling Liu
- National Engineering & Technology Research Center of Chirality Pharmaceutical, Linyi, Shandong, China
| | - Jian Xu
- National Engineering & Technology Research Center of Chirality Pharmaceutical, Linyi, Shandong, China
| | - Guoliang Cheng
- National Engineering & Technology Research Center of Chirality Pharmaceutical, Linyi, Shandong, China
| | - Juntang Xu
- Department of Cardiology, Peking University People's Hospital, China
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5
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Falkenberg K, Rønde Bjerg H, Yamani N, Olesen J. Sumatriptan Does Not Antagonize CGRP‐Induced Symptoms in Healthy Volunteers. Headache 2020; 60:665-676. [DOI: 10.1111/head.13747] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Katrine Falkenberg
- Danish Headache Centre Department of Neurology Rigshospitalet Glostrup University of Copenhagen Copenhagen Denmark
| | - Helene Rønde Bjerg
- Danish Headache Centre Department of Neurology Rigshospitalet Glostrup University of Copenhagen Copenhagen Denmark
| | - Nooshin Yamani
- Danish Headache Centre Department of Neurology Rigshospitalet Glostrup University of Copenhagen Copenhagen Denmark
| | - Jes Olesen
- Danish Headache Centre Department of Neurology Rigshospitalet Glostrup University of Copenhagen Copenhagen Denmark
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Falkenberg K, Bjerg HR, Olesen J. Subcutaneous sumatriptan reduces cilostazol induced headache in migraine patients. Cephalalgia 2020; 40:842-850. [PMID: 32216457 DOI: 10.1177/0333102420915166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The authors have previously tried to develop a model for the testing of novel drug candidates for migraine, using the headache and migraine provoking agent cilostazol. Previous studies have used sumatriptan tablets as the validating drug, but they were not sufficiently effective. In this study we test the effect of subcutaneous sumatriptan on cilostazol induced headache in patients with migraine without aura. METHOD Thirty patients with migraine without aura received 200 mg cilostazol on two different study days. The induced headache was treated with subcutaneous sumatriptan in a randomized, double-blind cross-over design. The patients filled out a self-reported headache questionnaire until 12 h after cilostazol. RESULTS All 30 patients experienced headache (range 3-10) on both study days and the headache fulfilled the criteria for a migraine-like attack in 73% on the sumatriptan day and in 77% on the placebo day. Sumatriptan injection reduced the headache score 2 h after treatment (p = 0.003). The difference between headache intensity on the sumatriptan day and the placebo day was significant at both 2 h (p = 0.01) and 4 h (p = 0.0007) after treatment. CONCLUSION Subcutaneous sumatriptan reduces cilostazol induced headache in migraine patients. The cilostazol model may be useful as a tool to test the potential of new anti-migraine drugs.Trial registration: The study is registered on clinicaltrials.gov (NCT03422796).
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Affiliation(s)
- Katrine Falkenberg
- Danish Headache Centre and Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Helene Rønde Bjerg
- Danish Headache Centre and Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Jes Olesen
- Danish Headache Centre and Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Glostrup, Denmark
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Ghanizada H, Al-Karagholi MAM, Arngrim N, Mørch-Rasmussen M, Metcalf-Clausen M, Larsson HBW, Amin FM, Ashina M. Investigation of sumatriptan and ketorolac trometamol in the human experimental model of headache. J Headache Pain 2020; 21:19. [PMID: 32093617 PMCID: PMC7038568 DOI: 10.1186/s10194-020-01089-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 02/12/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Pituitary adenylate cyclase-activating polypeptide-38 (PACAP38) induces headache in healthy volunteers but the precise mechanisms by which PACAP38 leads to headache are unclear. We investigated the headache preventive effect of sumatriptan and ketorolac on PACAP38-induced headache in healthy volunteers. In addition, we explored contribution of vascular mechanisms to PACAP38-induced headache using high resolution magnetic resonance angiography. METHODS Thirty-four healthy volunteers were divided in two groups (A and B) and received infusion of PACAP38 (10 picomol/kg/min) over 20 min. Group A was pretreated with intravenous sumatriptan (4 mg) or ketorolac (30 mg) 20 min before infusion of PACAP38. Group B received infusion of sumatriptan or ketorolac as post-treatment 90 min after infusion of PACAP38. In both experiments, we used a randomized, double-blind, cross-over design. We recorded headache characteristics and circumference of extra-intracerebral arteries. RESULTS We found no difference in AUC (0-6 h) of PACAP38-induced headache in group A, pretreated with sumatriptan or ketorolac (p = 0.297). There was no difference between sumatriptan and ketorolac in PACAP38-induced circumference change (AUCBaseline-110 min) of MMA (p = 0.227), STA (p = 0.795) and MCA (p = 0.356). In group B, post-treatment with ketorolac reduced PACAP38-headache compared to sumatriptan (p < 0.001). Post-treatment with sumatriptan significantly reduced the circumference of STA (p = 0.039) and MMA (p = 0.015) but not of MCA (p = 0.981) compared to ketorolac. In an explorative analysis, we found that pre-treatment with sumatriptan reduced PACAP38-induced headache compared to no treatment (AUC0-90min). CONCLUSIONS Post-treatment with ketorolac was more effective in attenuating PACAP38-induced headache compared to sumatriptan. Ketorolac exerted its effect without affecting PACAP38-induced arterial dilation, whereas sumatriptan post-treatment attenuated PACAP38-induced dilation of MMA and STA. Pre-treatment with sumatriptan attenuated PACAP38-induced headache without affecting PACAP38-induced arterial dilation. Our findings suggest that ketorolac and sumatriptan attenuated PACAP38-induced headache in healthy volunteers without vascular effects. TRIAL REGISTRATION Clinicaltrials.gov (NCT03585894). Registered 13 July 2018.
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Affiliation(s)
- Hashmat Ghanizada
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansens Vej 5, DK-2600, Glostrup, Denmark
| | - Mohammad Al-Mahdi Al-Karagholi
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansens Vej 5, DK-2600, Glostrup, Denmark
| | - Nanna Arngrim
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansens Vej 5, DK-2600, Glostrup, Denmark
| | - Mette Mørch-Rasmussen
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansens Vej 5, DK-2600, Glostrup, Denmark
| | - Matias Metcalf-Clausen
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansens Vej 5, DK-2600, Glostrup, Denmark
| | - Henrik Bo Wiberg Larsson
- Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Faisal Mohammad Amin
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansens Vej 5, DK-2600, Glostrup, Denmark
| | - Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Valdemar Hansens Vej 5, DK-2600, Glostrup, Denmark.
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Demartini C, Greco R, Zanaboni AM, Sances G, De Icco R, Borsook D, Tassorelli C. Nitroglycerin as a comparative experimental model of migraine pain: From animal to human and back. Prog Neurobiol 2019; 177:15-32. [DOI: 10.1016/j.pneurobio.2019.02.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 01/19/2019] [Accepted: 02/10/2019] [Indexed: 12/13/2022]
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Verkest C, Piquet E, Diochot S, Dauvois M, Lanteri-Minet M, Lingueglia E, Baron A. Effects of systemic inhibitors of acid-sensing ion channels 1 (ASIC1) against acute and chronic mechanical allodynia in a rodent model of migraine. Br J Pharmacol 2018; 175:4154-4166. [PMID: 30079481 DOI: 10.1111/bph.14462] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/28/2018] [Accepted: 07/26/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND PURPOSE Acid-sensing ion channels (ASICs) are neuronal proton sensors emerging as potential therapeutic targets in pain of the orofacial region. Amiloride, a non-specific ASIC blocker, has been shown to exert beneficial effects in animal models of migraine and in patients. We explored the involvement of the ASIC1-subtype in cutaneous allodynia, a hallmark of migraine affecting cephalic and extra-cephalic regions in about 70% of migrainers. EXPERIMENTAL APPROACH We investigated the effects of systemic injections of amiloride and mambalgin-1, a specific inhibitor of ASIC1a- and ASIC1b-containing channels, on cephalic and extra-cephalic mechanical sensitivity in a rodent model of acute and chronic migraine induced by i.p. injections of isosorbide dinitrate. KEY RESULTS I.v. injections of these inhibitors reversed cephalic and extra-cephalic acute cutaneous mechanical allodynia in rats, a single injection inducing a delay in the subsequent establishment of chronic allodynia. Both mambalgin-1 and amiloride also reversed established chronic allodynia. The anti-allodynic effects of mambalgin-1 were not altered in ASIC1a-knockout mice, showing the ASIC1a subtype is not involved in these effects which were comparable to those of the anti-migraine drug sumatriptan and of the preventive drug topiramate on acute and chronic allodynia respectively. A single daily injection of mambalgin-1 also had a significant preventive effect on allodynia chronification. CONCLUSIONS AND IMPLICATIONS These pharmacological data support the involvement of peripheral ASIC1-containing channels in migraine cutaneous allodynia as well as in its chronification. They highlight the therapeutic potential of ASIC1 inhibitors as both an acute and prophylactic treatment for migraine.
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Affiliation(s)
- Clément Verkest
- Université Côte d'Azur, CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France.,LabEx Ion Channel Science and Therapeutics, Valbonne, France.,FHU InovPain, Université Côte d'Azur, Nice, France
| | - Emilie Piquet
- FHU InovPain, Université Côte d'Azur, Nice, France.,CHU Nice, Hopital Cimiez, Département d'évaluation et de traitement de la douleur, Nice, France
| | - Sylvie Diochot
- Université Côte d'Azur, CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France.,LabEx Ion Channel Science and Therapeutics, Valbonne, France.,FHU InovPain, Université Côte d'Azur, Nice, France
| | - Mélodie Dauvois
- Université Côte d'Azur, CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France
| | - Michel Lanteri-Minet
- FHU InovPain, Université Côte d'Azur, Nice, France.,CHU Nice, Hopital Cimiez, Département d'évaluation et de traitement de la douleur, Nice, France.,Inserm/UdA, U1107, Neuro-Dol, Trigeminal Pain and Migraine, Université d'Auvergne, Clermont-Ferrand, France
| | - Eric Lingueglia
- Université Côte d'Azur, CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France.,LabEx Ion Channel Science and Therapeutics, Valbonne, France.,FHU InovPain, Université Côte d'Azur, Nice, France
| | - Anne Baron
- Université Côte d'Azur, CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, Valbonne, France.,LabEx Ion Channel Science and Therapeutics, Valbonne, France.,FHU InovPain, Université Côte d'Azur, Nice, France
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Falkenberg K, Olesen J. Pre-treatment with sumatriptan for cilostazol induced headache in healthy volunteers. J Headache Pain 2018; 19:71. [PMID: 30120600 PMCID: PMC6097976 DOI: 10.1186/s10194-018-0890-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 07/18/2018] [Indexed: 01/03/2023] Open
Abstract
Background Previous studies indicate that sumatriptan is not effective when second messenger levels are high as after cilostazol provocation. Therefore, we have conducted the present study, where sumatriptan is administrated as pretreatment before cAMP increases due to cilostazol intake. Our hypothesis was that pretreatment with sumatriptan would have a significant effect against cilostazol induced headache in healthy volunteers. Methods In a double-blind, randomized, crossover design, 30 healthy volunteers of both sexes received cilostazol 200 mg on two separate days, each day preceded by oral sumatriptan (2 × 50 mg) or placebo. Headache response and accompanying symptoms were registered in a questionnaire by the participants themselves. Results Cilostazol induced a mild to moderate headache in all but 3 participants (Range 0–7 on Numerical Rating Scale). There was no significant difference in headache score 2 h (p = 0.67) or 4 h (p = 0.1) after treatment between the 2 days. Median peak headache score was 1.5 (range 0–5) on the sumatriptan day and 2 (range 0–7) on the placebo day (p = 0.26). Conclusion Pre-treatment with sumatriptan prevents cilostazol induced headache from developing. However, the placebo group did not develop enough headache to get statistical significant results. The cilostazol pre-treatment model is valuable for experimental headache research and perhaps for testing drugs with another mechanism of action. Trial registration ClinicalTrials.gov Identifier: NCT03156920. Electronic supplementary material The online version of this article (10.1186/s10194-018-0890-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katrine Falkenberg
- Danish Headache Center and Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Copenhagen, Denmark.,Danish Headache Center, Department of Neurology N39, Rigshospitalet Glostrup, University of Copenhagen, Valdemar Hansens vej 5, DK-2600, Glostrup, Denmark
| | - Jes Olesen
- Danish Headache Center and Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Copenhagen, Denmark. .,Danish Headache Center, Department of Neurology N39, Rigshospitalet Glostrup, University of Copenhagen, Valdemar Hansens vej 5, DK-2600, Glostrup, Denmark.
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Falkenberg K, Dunga BÓÁ, Guo S, Ashina M, Olesen J. Cilostazol induced migraine does not respond to sumatriptan in a double blind trial. J Headache Pain 2018; 19:11. [PMID: 29396788 PMCID: PMC5796931 DOI: 10.1186/s10194-018-0841-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/24/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cilostazol is an inhibitor of phosphodiesterase 3 and thus causes accumulation of cAMP. It induces migraine-like attacks in migraine patients. Whether the cilostazol model responds to sumatriptan in migraine patients and therefore is valid for testing of future anti-migraine medications has never been investigated. METHODS In a cross-over study, 30 patients received cilostazol (200 mg p.o.) on two separate days each day followed by oral self-administered placebo or sumatriptan 50 mg. We recorded headache characteristics and associated symptoms using a questionnaire. The 30 participants were asked to subsequently treat their spontaneous attacks with sumatriptan (50 mg) or placebo in a double-blind cross-over design and 15 participants did so. RESULTS Cilostazol induced headache with some migraine characteristics in all participants; 18 patients on the sumatriptan day and 19 patients on the placebo day fulfilled criteria for a migraine-like attack. The difference in median headache intensity between sumatriptan and placebo at 2 h was not significant (p = 0.09), but it was at 4 h (p = 0.017). During spontaneous attacks, the difference between placebo and sumatriptan was not significant at 2 h (p = 0.26), but it was highly significant at 4 h (p = 0.006). CONCLUSION The cilostazol model in migraine patients could not be validated by a sufficient sumatriptan response. The model may perhaps respond to new drugs that act intracellularly or directly on ion channels. TRIAL REGISTRATION The study is registered on clinicaltrials.gov ( NCT02486276 ).
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Affiliation(s)
- Katrine Falkenberg
- Danish Headache Centre and Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Copenhagen, DK-2600, Glostrup, Denmark
| | - Bára Óladóttir Á Dunga
- Danish Headache Centre and Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Copenhagen, DK-2600, Glostrup, Denmark
| | - Song Guo
- Danish Headache Centre and Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Copenhagen, DK-2600, Glostrup, Denmark
| | - Messoud Ashina
- Danish Headache Centre and Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Copenhagen, DK-2600, Glostrup, Denmark
| | - Jes Olesen
- Danish Headache Centre and Department of Neurology, University of Copenhagen, Rigshospitalet Glostrup, Copenhagen, DK-2600, Glostrup, Denmark.
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Abstract
Migraine is a complex disorder characterized by recurrent episodes of headache, and is one of the most prevalent and disabling neurological disorders. A key feature of migraine is that various factors can trigger an attack, and this phenomenon provides a unique opportunity to investigate disease mechanisms by experimentally inducing migraine attacks. In this Review, we summarize the existing experimental models of migraine in humans, including those that exploit nitric oxide, histamine, neuropeptide and prostaglandin signalling. We describe the development and use of these models in the discovery of molecular pathways that are responsible for initiation of migraine attacks. Combining experimental human models with advanced imaging techniques might help to identify biomarkers of migraine, and in the ongoing search for new and better migraine treatments, human models will have a key role in the discovery of future targets for more-specific and more-effective mechanism-based antimigraine drugs.
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13
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Liu YY, Jiao ZY, Li W, Tian Q. PI3K/AKT signaling pathway activation in a rat model of migraine. Mol Med Rep 2017; 16:4849-4854. [PMID: 28791398 DOI: 10.3892/mmr.2017.7191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 05/03/2017] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to investigate phosphatidylinositol 4,5-bisphosphate 3‑kinase (PI3K)/protein kinase B (AKT) signaling pathway activation in a rat model of migraine. A total of 60 male Sprague‑Dawley rats were randomly divided into three groups: Blank control; suspension control; and migraine model. The model group was subcutaneously injected with a glyceryl trinitrate suspension, using an optimized Tassorelli method to establish a rat model of migraine. The activation status of the PI3K/AKT signaling pathway was assessed via measurement of the phosphorylated (p)‑AKT level. The level of serum 5‑hydroxytryptamine was detected using an ELISA. The mRNA and protein expression levels of PI3K and AKT, and protein levels of p‑AKT were detected by reverse transcription quantitative polymerase chain reaction and western blot analysis. Expression of the PI3K gene was significantly increased (P<0.01) 6‑24 h following the glyceryl trinitrate injection. There was no significant difference in the expression of AKT between any of the groups at any time. Expression of p‑AKT (S473) was significantly increased in the migraine model group (P<0.01) compared with the controls groups. Immunohistochemical analysis indicated that phosphatase and tensin homolog (PTEN) continuously decreased in the migraine model group during 1‑12 h, however this was only significant in the 12 h group. Levels of PTEN had increased again by 24 h. Glycogen synthase kinase (GSK)‑3β expression exhibited a similar expression pattern to PTEN. The results indicated that the PI3K/AKT signal pathway may be activated in the brain tissue of the rat migraine models. The inhibition of PTEN, which is an upstream modulator of the PI3K/AKT signaling pathway, may enhance the activation of phosphatidylinositol‑3,4,5‑triphosphate, thus inhibiting the expression of GSK-3β.
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Affiliation(s)
- Yun-Yong Liu
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| | - Zi-Yao Jiao
- Department of Anesthesiology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| | - Wei Li
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| | - Qian Tian
- Department of Neurology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
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Dallel R, Descheemaeker A, Luccarini P. Recurrent administration of the nitric oxide donor, isosorbide dinitrate, induces a persistent cephalic cutaneous hypersensitivity: A model for migraine progression. Cephalalgia 2017; 38:776-785. [DOI: 10.1177/0333102417714032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background A subgroup of migraineurs experience an increase in attack frequency leading to chronic migraine. Methods We assessed in rats the roles of dose and repeat administration of systemic isosorbide dinitrate (ISDN), a nitric oxide donor, on the occurrence and development of cephalic/face and extracephalic/hindpaw mechanical allodynia as a surrogate of migraine pain, and the effect of acute systemic sumatriptan and olcegepant and chronic systemic propranolol on these behavioral changes. Results A single high (H-ISDN) but not low (L-ISDN) dose of ISDN induces a reversible cephalic and extracephalic mechanical allodynia. However, with repeat administration, L-ISDN produces reversible cephalic but never extracephalic allodynia, whereas H-ISDN induces cephalic and extracephalic allodynia that are both potentiated. H-ISDN-induced cephalic allodynia thus gains persistency. Sumatriptan and olcegepant block single H-ISDN-induced behavioral changes, but only olcegepant reduces these acute changes when potentiated by repeat administration. Neither sumatriptan nor olcegepant prevent chronic cephalic hypersensitivity. Conversely, propranolol blocks repeat H-ISDN-induced chronic, but not acute, behavioral changes. Conclusions Repeated ISDN administration appears to be a naturalistic rat model for migraine progression, suitable for screening acute and preventive migraine therapies. It suggests frequent and severe migraine attacks associated with allodynia may be a risk factor for disease progression.
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Affiliation(s)
- Radhouane Dallel
- Université Clermont Auvergne, Clermont-Ferrand, France
- Centre Hospitalier Universitaire (CHU) de Clermont-Ferrand, Clermont-Ferrand, France
- Inserm, Neuro-Dol, F-63000 Clermont-Ferrand, France
| | - Amélie Descheemaeker
- Université Clermont Auvergne, Clermont-Ferrand, France
- Inserm, Neuro-Dol, F-63000 Clermont-Ferrand, France
| | - Philippe Luccarini
- Université Clermont Auvergne, Clermont-Ferrand, France
- Inserm, Neuro-Dol, F-63000 Clermont-Ferrand, France
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