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Chang CL, Cai Z, Hsu SYT. Gel-forming antagonist provides a lasting effect on CGRP-induced vasodilation. Front Pharmacol 2022; 13:1040951. [PMID: 36569288 PMCID: PMC9772450 DOI: 10.3389/fphar.2022.1040951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Migraine affects ∼15% of the adult population, and the standard treatment includes the use of triptans, ergotamines, and analgesics. Recently, CGRP and its receptor, the CLR/RAMP1 receptor complex, have been targeted for migraine treatment due to their critical roles in mediating migraine headaches. The effort has led to the approval of several anti-CGRP antibodies for chronic migraine treatment. However, many patients still suffer continuous struggles with migraine, perhaps due to the limited ability of anti-CGRP therapeutics to fully reduce CGRP levels or reach target cells. An alternative anti-CGRP strategy may help address the medical need of patients who do not respond to existing therapeutics. By serendipity, we have recently found that several chimeric adrenomedullin/adrenomedullin 2 peptides are potent CLR/RAMP receptor antagonists and self-assemble to form liquid gels. Among these analogs, the ADE651 analog, which potently inhibits CLR/RAMP1 receptor signaling, forms gels at a 6-20% level. Screening of ADE651 variants indicated that residues at the junctional region of this chimeric peptide are important for gaining the gel-forming capability. Gel-formation significantly slowed the passage of ADE651 molecules through Centricon filters. Consistently, subcutaneous injection of ADE651 gel in rats led to the sustained presence of ADE651 in circulation for >1 week. In addition, analysis of vascular blood flow in rat hindlimbs showed ADE651 significantly reduces CGRP-induced vasodilation. Because gel-forming antagonists could have direct and sustained access to target cells, ADE651 and related antagonists for CLR/RAMP receptors may represent promising candidates for targeting CGRP- and/or adrenomedullin-mediated headaches in migraine patients.
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Affiliation(s)
- Chia Lin Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital Linkou Medical Center, Chang Gung University, Taoyuan, Taiwan
| | - Zheqing Cai
- CL Laboratory LLC, Gaithersburg, MD, United States
| | - Sheau Yu Teddy Hsu
- Adepthera LLC, San Jose, CA, United States,*Correspondence: Sheau Yu Teddy Hsu,
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Ray JC, Allen P, Bacsi A, Bosco JJ, Chen L, Eller M, Kua H, Lim LL, Matharu MS, Monif M, Ruttledge M, Stark RJ, Hutton EJ. Inflammatory complications of CGRP monoclonal antibodies: a case series. J Headache Pain 2021; 22:121. [PMID: 34625019 PMCID: PMC8501661 DOI: 10.1186/s10194-021-01330-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/16/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Calcitonin gene-related peptide (CGRP) is expressed throughout the body and is a known mediator of migraine, exerting this biological effect through activation of trigeminovascular, meningeal and associated neuronal pathways located in close proximity to the central nervous system. Monoclonal antibodies (mAb) targeting the CGRP pathway are an effective new preventive treatment for migraine, with a generally favourable adverse event profile. Pre-clinical evidence supports an anti-inflammatory/immunoregulatory role for CGRP in other organ systems, and therefore inhibition of the normal action of this peptide may promote a pro-inflammatory response. CASES We present a case series of eight patients with new or significantly worsened inflammatory pathology in close temporal association with the commencement of CGRP mAb therapy. CONCLUSION This case series provides novel insights on the potential molecular mechanisms and side-effects of CGRP antagonism in migraine and supports clinical vigilance in patient care going forward.
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Affiliation(s)
- Jason C Ray
- Department of Neurology, Alfred Hospital, Commercial Melbourne 3004, Melbourne, Australia. .,Department of Neurology, Austin Health, 145 Studley Road, 3084, Heidelberg, Germany. .,Department of Neuroscience, Monash University, Vic, Melbourne, 3004, Australia.
| | - Penelope Allen
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Department of Surgery (Ophthalmology), University of Melbourne, Parkville, Australia
| | - Ann Bacsi
- Integrated Specialist Medical Care, Sydney, Australia
| | - Julian J Bosco
- Department of Allergy, asthma and clinical immunology, Alfred Hospital, Commercial Road 3004, Melbourne, Australia.,Central Clinical School, Faculty of Medicine Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Luke Chen
- Department of Neuroscience, Monash University, Vic, Melbourne, 3004, Australia.,Otoneurology Diagnostic Unit, Alfred Hospital, Commercial Rd 3004, Melbourne, VIC, Australia
| | - Michael Eller
- Department of Neurology, Monash Medical Centre, Vic, Melbourne, Australia.,School of Clinical Sciences, Monash University, Vic, Melbourne, Australia
| | - Hock Kua
- Department of Pathology, Monash Medical Centre, Vic, Melbourne, Australia
| | - Lyndell L Lim
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,Department of Surgery (Ophthalmology), University of Melbourne, Parkville, Australia
| | - Manjit S Matharu
- University College London (UCL) Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, University College London, Gower Street WC1E 6BT, London, UK
| | - Mastura Monif
- Department of Neuroscience, Monash University, Vic, Melbourne, 3004, Australia.,Department of Neurology, Royal Melbourne Hospital, Vic, Parkville, 3050, Australia.,MS and Neuroimmunology Department, Alfred Hospital, Vic, Melbourne, 3004, Australia
| | - Martin Ruttledge
- Consultant Neurologist & Headache Clinical Lead, Beaumont Hospital, Beaumont Road, Dublin, Ireland
| | - Richard J Stark
- Department of Neurology, Alfred Hospital, Commercial Melbourne 3004, Melbourne, Australia.,Department of Neuroscience, Monash University, Vic, Melbourne, 3004, Australia
| | - Elspeth J Hutton
- Department of Neurology, Alfred Hospital, Commercial Melbourne 3004, Melbourne, Australia.,Department of Neuroscience, Monash University, Vic, Melbourne, 3004, Australia
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Abstract
Schwann cells are components of the peripheral nerve myelin sheath, which supports and nourishes axons. Upon injury of the trigeminal nerve, Schwann cells are activated and cause trigeminal neuralgia by engulfing the myelin sheath and secreting various neurotrophic factors. Further, Schwann cells can repair the damaged nerve and thus alleviate trigeminal neuralgia. Here, we briefly describe the development and activation of Schwann cells after nerve injury. Moreover, we expound on the occurrence, regulation, and treatment of trigeminal neuralgia; further, we point out the current research deficiencies and future research directions.
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Affiliation(s)
- Jia-Yi Liao
- Stomatology College of Nanchang University, Nanchang, China
| | - Tian-Hua Zhou
- Basic Medical School, Nanchang University, Nanchang, China
| | - Bao-Kang Chen
- First Clinical Medical College of Nanchang University, Nanchang, China
| | - Zeng-Xu Liu
- Department of Anatomy, Basic Medical School, Nanchang University, Nanchang, China
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Abstract
The new wave of anti-migraine agents is nothing less than a milestone in our battle to manage this devastating disease. However, concerns have recently increased regarding the safety of these drugs. CGRP, while known as a potent vasodilator, is also a key neural and immune modulator. The roles of CGRP in immune determination, have been studied in depth, with particular focus on its functional significance with respect to common immune challenges i.e., bacterial, viral, fungal and parasitic infections. This review discusses many potential areas of concern in regard to blocking CGRP function and its potential influence on immune milieus during infection, and the risk of adverse effects. Finally, this review recommends specific measures to be taken into consideration when administering anti-CGRP/CGRPR agents.
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Cavestro C, Ferrero M, Mandrino S, Di Tavi M, Rota E. Novelty in Inflammation and Immunomodulation in Migraine. Curr Pharm Des 2020; 25:2919-2936. [PMID: 31686633 DOI: 10.2174/1381612825666190709204107] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 06/30/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Migraine is a diffuse and disabling disease. Its pathophysiology is complex and involves both central and peripheral dysfunctions. OBJECTIVE This review will discuss the pathogenesis of migraine from the origin of the neuro-inflammatory theory, to the modern pathophysiological model and the latest therapies. METHODS PUBMED and EMBASE (up to May 2019) were searched for: migraine, inflammation, immunomodulation. An additional search was carried out from the bibliography of previous review articles. RESULTS Migraine was thought to be mainly a vascular disorder, according to the so-called "vascular theory". Based on animal models, a new hypothesis called "the neuro-inflammatory" was conceived at the end of the 20th century. The growing knowledge about the trigeminovascular system and its role in the inflammatory-pain pathway, allowed to identify other specific neurotransmitters, such as the Calcitonin Gene-Related Peptide and Pituitary Adenylate Cyclase-Activating Peptide. Evidence was provided that the inflammatory-pain system could become sensitised and, due to this sensitisation, the pain could also perpetuate, even in the absence of any triggers of the migraine attack. At last, brain immune cells modification during cortical spreading depression in migraine was demonstrated, along with the existence and function of the glymphatic system. The better comprehension of the immune system abnormalities allowed the development of new immunomodulating drugs: the monoclonal antibodies against the CGRP or the CGRP receptor. Moreover, new insights into the molecular mechanism of CGRP, and the function of C-fibres and Aδ-fibres, highlighted the mechanism of action of Botulinum Toxin type A in the treatment of chronic migraine.
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Affiliation(s)
- Cinzia Cavestro
- Department of Neurology, Headache Centre, ASL CN2, Alba, Italy
| | | | - Silvia Mandrino
- Department of Neurology, Headache Centre, ASL CN2, Alba, Italy
| | - Marco Di Tavi
- Department of Neurology, Headache Centre, ASL CN2, Alba, Italy
| | - Eugenia Rota
- Neurology Unit, San Giacomo Hospital, Novi Ligure, ASL AL, Italy
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