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Eller MT, Frank F, Kaltseis K, Karisik A, Knoflach M, Broessner G. Novel Calcitonin Gene-Related Peptide (CGRP) Interfering Migraine Therapies and Stroke-A Review. Int J Mol Sci 2024; 25:11685. [PMID: 39519240 PMCID: PMC11546425 DOI: 10.3390/ijms252111685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2024] [Revised: 10/29/2024] [Accepted: 10/29/2024] [Indexed: 11/16/2024] Open
Abstract
Migraine and stroke are neurological disorders with significant global prevalence and impact. Recent advances in migraine therapy have focused on the calcitonin gene-related peptide (CGRP) pathway. This review examines the shared pathomechanisms between migraine and stroke, with emphasis on the role of CGRP. We analyze the current literature on CGRP's functions in cerebrovascular regulation, edema formation, neuroinflammation, and neuroprotection. CGRP acts as a potent vasodilator and plays a crucial role in trigeminovascular activation during migraine attacks. In stroke, CGRP has demonstrated neuroprotective effects by improving collateral circulation and reducing ischemia-reperfusion injury. Concerns have been raised about the potential impact of CGRP inhibitors on stroke risk and outcomes. Studies in animals suggest that CGRP receptor antagonists may worsen cerebral ischemia by impairing collateral flow. We discuss the implications of these findings for the use of CGRP-targeting therapies in migraine patients, especially those at increased risk of stroke. Additionally, we explore the complex interplay between CGRP, endothelial function, and platelet activity in both conditions. This review highlights the need for further research to elucidate the long-term cerebrovascular safety of CGRP pathway inhibitors and to identify potential subgroups of migraine patients who may be at higher risk of adverse cerebrovascular events with these novel therapies.
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Affiliation(s)
- Michael Thomas Eller
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.T.E.)
| | - Florian Frank
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.T.E.)
| | - Katharina Kaltseis
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.T.E.)
| | - Anel Karisik
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.T.E.)
- VASCage—Centre on Clinical Stroke Research, 6020 Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.T.E.)
- VASCage—Centre on Clinical Stroke Research, 6020 Innsbruck, Austria
| | - Gregor Broessner
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.T.E.)
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Leech T, Peiris M. Mucosal neuroimmune mechanisms in gastro-oesophageal reflux disease (GORD) pathogenesis. J Gastroenterol 2024; 59:165-178. [PMID: 38221552 PMCID: PMC10904498 DOI: 10.1007/s00535-023-02065-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/30/2023] [Indexed: 01/16/2024]
Abstract
Gastro-oesophageal reflux disease (GORD) is a chronic condition characterised by visceral pain in the distal oesophagus. The current first-line treatment for GORD is proton pump inhibitors (PPIs), however, PPIs are ineffective in a large cohort of patients and long-term use may have adverse effects. Emerging evidence suggests that nerve fibre number and location are likely to play interrelated roles in nociception in the oesophagus of GORD patients. Simultaneously, alterations in cells of the oesophageal mucosa, namely epithelial cells, mast cells, dendritic cells, and T lymphocytes, have been a focus of GORD research for several years. The oesophagus of GORD patients exhibits both macro- and micro-inflammation as a response to chronic acidic reflux at the epithelium. In other conditions of the GI tract, such as IBS and IBD, well-characterised bidirectional processes between immune cells and mucosal nerve fibres contribute to pathogenesis and symptom generation. Sensory alterations in these conditions such as nerve fibre outgrowth and hypersensitivity can be driven by inflammatory processes, which promote visceral pain signalling. This review will examine what is currently known of the molecular pathways linking inflammation and sensory perception leading to the development of GORD symptoms and explore potentially relevant mechanisms in other GI regions which may indicate new areas in GORD research.
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Affiliation(s)
- Tom Leech
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Madusha Peiris
- Centre for Neuroscience, Surgery and Trauma, Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
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Szőke É, Helyes Z. Molecular Links between Sensory Nerves, Inflammation, and Pain 2.0. Int J Mol Sci 2023; 24:12243. [PMID: 37569621 PMCID: PMC10418333 DOI: 10.3390/ijms241512243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Capsaicin-sensitive peptidergic sensory nerves mediate triple actions: besides transmitting sensory and pain signals to the central nervous system (afferent function), they also have local and systemic efferent functions [...].
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Affiliation(s)
- Éva Szőke
- Department of Pharmacology and Pharmacotherapy, Medical School, Eötvös Loránd Research Network, University of Pécs, Szigeti Str. 12, H-7624 Pécs, Hungary;
- National Laboratory for Drug Research and Development, H-1117 Budapest, Hungary
| | - Zsuzsanna Helyes
- Department of Pharmacology and Pharmacotherapy, Medical School, Eötvös Loránd Research Network, University of Pécs, Szigeti Str. 12, H-7624 Pécs, Hungary;
- National Laboratory for Drug Research and Development, H-1117 Budapest, Hungary
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Wang K, Fenton BT, Deng Y, Anthony SE, Dao VX, Schindler E, Lipton RB, Guirguis A, Skanderson M, Seng EK, Sico JJ. Calcitonin Gene-Related Peptide Monoclonal Antibodies and Risk of SARS-CoV-2 Infection and Severe COVID-19 Outcomes Among Veterans With Migraine Disorder. JAMA Netw Open 2023; 6:e2326371. [PMID: 37523183 PMCID: PMC10391301 DOI: 10.1001/jamanetworkopen.2023.26371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/15/2023] [Indexed: 08/01/2023] Open
Abstract
Importance Calcitonin gene-related peptide (CGRP), a neuropeptide involved in migraine pathophysiology, is also a key neuroimmune modulator. CGRP antagonists may help mitigate the hyperinflammatory response observed in patients with COVID-19; however, findings from the literature are contradictory, and to date, no study has investigated the safety and effectiveness of CGRP antagonists against COVID-19. Objective To evaluate the association between CGRP monoclonal antibody (mAb) treatment and risk of SARS-CoV-2 infection and sequela hospitalization, requiring supplemental oxygen, use of mechanical ventilation, or death. Design, Setting, and Participants This retrospective cohort study analyzed the electronic health records of US veterans aged 18 to 65 years who were diagnosed with migraine disorder and were at risk of COVID-19 between January 20, 2020, and May 19, 2022. Exposure Initiation of CGRP mAbs. Main Outcomes and Measures The main outcome was cumulative incidence of SARS-CoV-2 infection. Odds of 30-day hospitalization, requiring supplemental oxygen, use of mechanical ventilation, or death were secondary outcomes. Results Among 8 178 652 eligible person-trials (354 294 veterans), 9992 (mean [SD] age, 46.0 [9.5] years; 53.9% male) initiated CGRP mAbs and 8 168 660 (mean [SD] age, 46.6 [10.2] years; 65.7% male) did not initiate CGRP mAbs. Over a 28-month follow-up period, 1247 initiators (12.5%) and 780 575 noninitiators (9.6%) tested positive for SARS-CoV-2. After censoring persons who deviated from treatment, the incidence was 7.4 cases per 1000 person-months among initiators and 6.9 per 1000 person-months among noninitiators. The inverse probability-weighted observational analogs of intention-to-treat and per-protocol hazard ratios were 0.95 (95% CI, 0.89-1.01) and 0.93 (95% CI, 0.86-1.02), respectively. No significant differences in the likelihood of hospitalization (odds ratio [OR], 0.93; 95% CI, 0.62-1.41), requiring supplemental oxygen (OR, 0.77; 95% CI, 0.45-1.30), use of mechanical ventilation (OR, 0.85; 95% CI, 0.26-2.84), or death (OR, 0.67; 95% CI, 0.09-5.23) were observed between CGRP mAb initiators and noninitiators who tested positive for SARS-CoV-2. Conclusions and Relevance In this cohort study, CGRP mAb treatment was not associated with positive SARS-CoV-2 test results or risk of severe COVID-19 outcomes, suggesting that CGRP mAbs may be used for migraine prevention during the COVID-19 pandemic. Given the few events of requiring supplemental oxygen, use of mechanical ventilation, and death, replication analysis in a larger sample of patients later in the course of disease is warranted.
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Affiliation(s)
- Kaicheng Wang
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Brenda T. Fenton
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut
- Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven
| | - Yanhong Deng
- Yale Center for Analytic Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Sarah E. Anthony
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Vinh X. Dao
- Headache Center of Excellence, VA Minneapolis Health Care System, Minneapolis, Minnesota
| | - Emmanuelle Schindler
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
- Headache Center of Excellence, VA Connecticut Healthcare System, West Haven
| | - Richard B. Lipton
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
| | - Alexander Guirguis
- Headache Center of Excellence, VA Connecticut Healthcare System, West Haven
| | - Melissa Skanderson
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut
| | - Elizabeth K. Seng
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Jason J. Sico
- Research, Education, Evaluation and Engagement Activities Center for Headache, Headache Centers of Excellence, US Department of Veterans Affairs, Orange, Connecticut
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
- Headache Center of Excellence, VA Connecticut Healthcare System, West Haven
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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