1
|
Russo AF, Hay DL. CGRP physiology, pharmacology, and therapeutic targets: migraine and beyond. Physiol Rev 2023; 103:1565-1644. [PMID: 36454715 PMCID: PMC9988538 DOI: 10.1152/physrev.00059.2021] [Citation(s) in RCA: 58] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 11/23/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022] Open
Abstract
Calcitonin gene-related peptide (CGRP) is a neuropeptide with diverse physiological functions. Its two isoforms (α and β) are widely expressed throughout the body in sensory neurons as well as in other cell types, such as motor neurons and neuroendocrine cells. CGRP acts via at least two G protein-coupled receptors that form unusual complexes with receptor activity-modifying proteins. These are the CGRP receptor and the AMY1 receptor; in rodents, additional receptors come into play. Although CGRP is known to produce many effects, the precise molecular identity of the receptor(s) that mediates CGRP effects is seldom clear. Despite the many enigmas still in CGRP biology, therapeutics that target the CGRP axis to treat or prevent migraine are a bench-to-bedside success story. This review provides a contextual background on the regulation and sites of CGRP expression and CGRP receptor pharmacology. The physiological actions of CGRP in the nervous system are discussed, along with updates on CGRP actions in the cardiovascular, pulmonary, gastrointestinal, immune, hematopoietic, and reproductive systems and metabolic effects of CGRP in muscle and adipose tissues. We cover how CGRP in these systems is associated with disease states, most notably migraine. In this context, we discuss how CGRP actions in both the peripheral and central nervous systems provide a basis for therapeutic targeting of CGRP in migraine. Finally, we highlight potentially fertile ground for the development of additional therapeutics and combinatorial strategies that could be designed to modulate CGRP signaling for migraine and other diseases.
Collapse
Affiliation(s)
- Andrew F Russo
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa
- Department of Neurology, University of Iowa, Iowa City, Iowa
- Center for the Prevention and Treatment of Visual Loss, Department of Veterans Affairs Health Center, Iowa City, Iowa
| | - Debbie L Hay
- Department of Pharmacology and Toxicology, University of Otago, Dunedin, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, School of Biological Sciences, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
2
|
Martelletti P, Curto M. Cluster Headache is Still Lurking in the Shadows. Pain Ther 2021; 10:777-781. [PMID: 34091819 PMCID: PMC8586408 DOI: 10.1007/s40122-021-00278-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/27/2021] [Indexed: 02/05/2023] Open
Abstract
Cluster headache, apart from its legendary reputation as the most violent headache that can exist, suffers from an average 60-month delay in diagnosis. The simplicity of the clinical manifestations, although dramatic, makes this delay inexplicable. The education of emergency department physicians and various specialists not specifically dedicated to headaches allows cluster headache to remain in a lurking position with flourishing periods of disease that are often unpredictable in both onset and disappearance. Older drugs have always shown high efficacy but also an equally high rate of adverse events, often discouraging their appropriate use. The availability of a new drug class such as monoclonal antibodies for calcitonin gene-related peptide or its receptor (CGRP(r)), which have already been efficient for migraine, shows a jeopardized geography of access in the world, and this favors the progression of the episodic form into chronic and of the chronic into refractory.
Collapse
Affiliation(s)
- Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy.
- Regional Referral Headache Centre, Sant'Andrea University Hospital, Rome, Italy.
| | - Martina Curto
- Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
- International Consortium for Mood Psychotic and Mood Disorders Research, McLean Hospital, Belmont, MA, USA
- Department of Mental Health, ASL Roma 3, Centro di Salute Mentale XI Municipio, Rome, Italy
| |
Collapse
|
3
|
Toth D, Szabo E, Tamas A, Juhasz T, Horvath G, Fabian E, Opper B, Szabo D, Maugeri G, D'Amico AG, D'Agata V, Vicena V, Reglodi D. Protective Effects of PACAP in Peripheral Organs. Front Endocrinol (Lausanne) 2020; 11:377. [PMID: 32765418 PMCID: PMC7381171 DOI: 10.3389/fendo.2020.00377] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/12/2020] [Indexed: 12/21/2022] Open
Abstract
Pituitary adenylate cyclase activating polypeptide (PACAP) is a neuropeptide widely distributed in the nervous system, where it exerts strong neuroprotective effects. PACAP is also expressed in peripheral organs but its peripheral protective effects have not been summarized so far. Therefore, the aim of the present paper is to review the existing literature regarding the cytoprotective effects of PACAP in non-neuronal cell types, peripheral tissues, and organs. Among others, PACAP has widespread expression in the digestive system, where it shows protective effects in various intestinal pathologies, such as duodenal ulcer, small bowel ischemia, and intestinal inflammation. PACAP is present in both the exocrine and endocrine pancreas as well as liver where it reduces inflammation and steatosis by interfering with hepatic pathology related to obesity. It is found in several exocrine glands and also in urinary organs, where, with its protective effects being mainly published regarding renal pathologies, PACAP is protective in numerous conditions. PACAP displays anti-inflammatory effects in upper and lower airways of the respiratory system. In the skin, it is involved in the development of inflammatory pathology such as psoriasis and also has anti-allergic effects in a model of contact dermatitis. In the non-neuronal part of the visual system, PACAP showed protective effects in pathological conditions of the cornea and retinal pigment epithelial cells. The positive role of PACAP has been demonstrated on the formation and healing processes of cartilage and bone where it also prevents osteoarthritis and rheumatoid arthritis development. The protective role of PACAP was also demonstrated in the cardiovascular system in different pathological processes including hyperglycaemia-induced endothelial dysfunction and age-related vascular changes. In the heart, PACAP protects against ischemia, oxidative stress, and cardiomyopathies. PACAP is also involved in the protection against the development of pre-senile systemic amyloidosis, which is presented in various peripheral organs in PACAP-deficient mice. The studies summarized here provide strong evidence for the cytoprotective effects of the peptide. The survival-promoting effects of PACAP depend on a number of factors which are also shortly discussed in the present review.
Collapse
Affiliation(s)
- Denes Toth
- Department of Forensic Medicine, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
| | - Edina Szabo
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
| | - Andrea Tamas
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
| | - Tamas Juhasz
- Department of Anatomy, Histology and Embryology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Department of Biomedical and Biotechnological Sciences, Section of Human Anatomy and Histology, University of Catania, Catania, Italy
| | - Gabriella Horvath
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
| | - Eszter Fabian
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
| | - Balazs Opper
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
| | - Dora Szabo
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Grazia Maugeri
- Department of Biomedical and Biotechnological Sciences, Section of Human Anatomy and Histology, University of Catania, Catania, Italy
| | - Agata G. D'Amico
- Department of Drug Sciences, University of Catania, Catania, Italy
| | - Velia D'Agata
- Department of Biomedical and Biotechnological Sciences, Section of Human Anatomy and Histology, University of Catania, Catania, Italy
| | - Viktoria Vicena
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
| | - Dora Reglodi
- Department of Anatomy, MTA-PTE PACAP Research Team, University of Pécs Medical School, Pécs, Hungary
- *Correspondence: Dora Reglodi
| |
Collapse
|
4
|
Li X, Dai Q, Shi Z, Chen H, Hu Y, Wang X, Zhang X, Tian G. Clinical Efficacy and Safety of Electroacupuncture in Migraine Treatment: A Systematic Review and Network Meta-Analysis. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2019; 47:1755-1780. [PMID: 31801357 DOI: 10.1142/s0192415x19500897] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Considering the heavy burden of migraine, it is essential to update insufficient and/or outdated clinical evidence supporting electroacupuncture (EA) in migraine therapy. In this study, a literature search of seven medical databases was performed. After data extraction and quality evaluation, 13 randomized controlled trials, including 1559 patients, were assessed in this analysis. Results demonstrated that EA was superior to control treatment (Western medicine, sham-EA, blank control, acupuncture, and acupoint catgut embedding) according to the visual analog scale (VAS) score, frequency of headache attack (Western medicine, sham-EA, blank control), self-rating anxiety scale (SAS [blank control]), self-rating depression score (SDS [Western medicine and blank control]), and clinical efficiency (Western medicine and sham-EA) after treatment ([Formula: see text]). Results of network meta-analysis (for VAS, SAS, and SDS) demonstrated statistically significant differences in VAS scores for EA compared with sham-EA, acupuncture with sham-EA, acupoint catgut embedding with sham-EA, and acupoint catgut embedding with blank control. Rank probability analysis of VAS, SAS, and SDS scores all demonstrated that EA ranked first. Most studies were symmetrically distributed on both sides of the midline in funnel plots for VAS, SAS, and SDS, which indicated a low likelihood of small sample effects. Sensitivity analysis confirmed the stability of the studies included in this research. EA is one of several effective treatments for migraine pain symptoms, and, to some extent, anxiety and depression. Nevertheless, multi-center studies with large sample sizes and/or well-designed randomized controlled trials (RCTs) will be needed in the future.
Collapse
Affiliation(s)
- Xinyi Li
- Key Laboratory of Chinese Internal, Medicine of MOE and Beijing, P. R. China
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, P. R. China
| | - Qianqian Dai
- Key Laboratory of Chinese Internal, Medicine of MOE and Beijing, P. R. China
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, P. R. China
| | - Zhaofeng Shi
- Key Laboratory of Chinese Internal, Medicine of MOE and Beijing, P. R. China
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, P. R. China
| | - Heqing Chen
- Key Laboratory of Chinese Internal, Medicine of MOE and Beijing, P. R. China
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, P. R. China
| | - Yeyin Hu
- Key Laboratory of Chinese Internal, Medicine of MOE and Beijing, P. R. China
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, P. R. China
| | - Xiaoli Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, P. R. China
| | - Xiatian Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, P. R. China
| | - Guihua Tian
- Key Laboratory of Chinese Internal, Medicine of MOE and Beijing, P. R. China
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, P. R. China
| |
Collapse
|