CGRP Receptor Antagonism and Migraine Therapy

被引:18
作者
Edvinsson, Lars [1 ,2 ,3 ]
Warfvinge, Karin [1 ,2 ,3 ]
机构
[1] Lund Univ, Inst Clin Sci, Dept Med, Lund, Sweden
[2] Univ Lund Hosp, S-22185 Lund, Sweden
[3] Dept Expt Res, Glostrup, Denmark
关键词
Migraine; CGRP; telcagepant; trigeminovascular reflex; CGRP receptor antagonists; GENE-RELATED PEPTIDE; CONTROLLED-TRIAL; IN-VIVO; ATTACKS; TELCAGEPANT; BIBN4096BS; ARTERY; BRAIN; LOCALIZATION; ACTIVATION;
D O I
10.2174/13892037113149990055
中图分类号
Q5 [生物化学]; Q7 [分子生物学];
学科分类号
071010 ; 081704 ;
摘要
Migraine is the most prevalent of the neurological disorders and can affect the patient throughout the lifetime. Calcitonin gene-related peptide (CGRP) is a neuropeptide that is expressed in the central and peripheral nervous systems. It is now 2 decades since it was proposed to be involved in migraine pathophysiology. The cranial sensory system contains C-fibers storing CGRP and trigeminal nerve activation and acute migraine attacks result in release of CGRP. The CGRP receptor consists of a complex of calcitonin receptor-like receptor (CLR), receptor activity-modifying protein 1 (RAMP1) and receptor component protein (RCP). At the central synapses in the trigeminal nucleus caudalis, CGRP acts postjunctionally on second-order neurons to transmit pain signals centrally via brainstem and midbrain to thalamus and higher cortical pain regions. CLR and RAMPs are widely expressed throughout the brain, in the trigeminal ganglion and in intracranial arteries. CGRP does not induce neurogenic inflammation or sensitization at peripheral meningeal sites but relays nociceptive information from trigeminal primary afferent neurons to the second-order neurons in the spinal trigeminal nucleus neurons. CGRP receptor antagonists have been developed as novel antimigraine drugs and found to be effective in the treatment of acute migraine attacks. Other ways to stop CGRP activity has been introduced recently through antibodies against CGRP and the CGRP receptor. While the CGRP receptors are expressed both in the CNS and at various places related to the trigeminal system the exact site of action for their therapy effect is still unresolved but the new approaches may resolve this.
引用
收藏
页码:386 / 392
页数:7
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