No momento em que há a agressão tecidual e a defesa inata é deflagrada, mediadores químicos são liberados no local afetado. Esses mediadores podem ser de origem celular tais como CGRP, VEGF e TGFß. Os objetivos desta pesquisa foram avaliar a expressão e distribuição de CGRP, TGFß e VEGF na gengiva do primeiro molar inferior esquerdo de rato no 7 e 14 dias após a indução por ligadura; a expressão e distribuição de CGRP, TGFß e VEGF na gengiva do dente contralateral correspondente sem ligadura, no 7 e 14 dias, e se a indução da periodontite por ligadura no dente experimental provoca uma inflamação na gengiva do dente contralateral correspondente no 7 e 14 dias após a ligadura. Para o desenvolvimento deste trabalho foram selecionados 15 ratos Rattus Novergicus, Albinus, Wistar. O grupo experimental de 12 ratos foi dividido em 2 subgrupos compostos por 6 ratos cada um deles distribuídos da seguinte maneira: os do subgrupo A1 permaneceram com a ligadura no primeiro molar inferior esquerdo por 7 dias e foram sacrificados; os do subgrupo A-2 -permaneceram com a ligadura no primeiro molar inferior esquerdo por 14 dias e foram sacrificados. Outros três animais constituíram o grupo controle. Após o sacrifício dos 12 animais dos grupos experimentais e controle suas mandíbulas foram colocadas em ácido etilenodiaminotetracético (EDTA) neutro para sofrerem descalcificação. Então foram processadas para inclusão em parafina e os cortes histológicos foram corados pela hematoxilina-eosina e submetidos à técnica imunohistoquímica para imunomarcação de CGRP, VEGF e TGFß. Aos 7 dias de ligadura observou-se na lâmina própria gengival, epitélio juncional e epitélio oral, expressiva marcação para CGRP. A expressão de VEGF foi intensa na lamina própria e com pouca ou nenhuma marcação no epitélio oral e juncional. O TGFß apresentou pouca marcação na lâmina própria ou nenhuma marcação no epitélio oral e juncional. Aos 14 dias de ligadura houve expressiva marcação de CGRP na lâmina própria, epitélios oral e juncional. O VEGF e o TGFß apresentaram muita marcação na lâmina própria e pouca ou nenhuma marcação no epitélio oral e juncional. Na gengiva dos dentes contralaterais nos 7 e 14 dias houve pouca marcação do CGRP do TGFß na lâmina própria e muita marcação do VEGF. Na gengiva dos dentes controle observou-se muita marcação do CGRP no epitélio juncional e oral e na lâmina própria. O TGFß e o VEGF se expressaram muito pouco ou não se expressaram. Devido à marcação expressiva do VEGF na lâmina própria dos dentes contralaterais, permanece inconclusiva a adequação do uso dos dentes contralaterais nos estudos experimentais das doenças periodontais, embora a expressão de TGFß e CGRP tenham sido menores nestes dentes. A maior marcação do CGRP, VEGF e TGFß nos animais com 14 dias de ligadura do que aos 7 dias demonstra a progressão do processo inflamatório crônico, não se observando processo de reparação cicatricial. / At the time of the tissue aggression the innate defense is triggered and the chemical mediators are released in the affected site. These mediators may have cell origin as the CGRP, VEGF and TGFß. The aim of this research were to evaluate the expression and distribution of the CGRP, VEGF and TGFß in the gingiva of the lower left first molar of rats in the seven and fourteen days after the ligature for inflammation induction; to analyse the expression and distribution of the CGRP, VEGF and TGFß in the gingiva of the correspondent counter lateral tooth without ligature in the seven and fourteen days and if the induction of periodontitis causes gingival inflammation of the counter lateral tooth after seven and fourteen days after ligature. For the development of this work were selected fifteen Rattus Novergicus, Albinus,Wistar. The experimental group of 12 rats was divided into 2 groups consisting of 6 rats each distributed of the following manner: the subgroup A1 remained with ligature in the first molar and left for 7 days before the sacrificed and the subgroup A-2 remained with the ligature for 14 days before the sacrificed. Another 3 animals constituted the control group. After the sacrificed of the 12 experimental and 3 control animals were immersedin neutral ethylenidiaminetetracetic (EDTA) for the decalcification. Then were processed for paraffin embedding. The sections were stained with hematoxylin-eosin and submitted to immunohistochemical techniques to imunostaining for CGRP, VEGF and TGFß. At 7 days of ligature was observed in the gingival lamina propria, junctional epithelium and oral epithelium, strong staining for CGRP. The intensive expression of VEGF occur in the lamina propria and scarce or no staining in the oral and junctional epithelium. The TGFß shows scarce staining in the lamina propria and no staining in the oral and junctional epithelium. At the fourteen days of ligature we observed strong staining of CGRP in the lamina propria and oral and junctional epithelium. The VEGF and TGFß show strong staining in the lamina propria and scarce or no staining in the junctional and oral epithelium. At the gingival of the counterlateral teeth in the 7 and 14 days there was scarce staining for CGRP and TGFß in the lamina propria and strong staining to VEGF. In the gingival of couterlateral teeth there was strong staining to CGRP in the junctional and oral epithelium and lamina propria. The TGFß and VEGF show scarce or none staining. Because the strong staining of VEGF in the lamina propria of the counterlateral teeth remain inconclusive the adequacy of the use of the counterlateral teeth in the experimental studies of the periodontal diseases, though the expression of the TGFß and CGRP has been smaller in this teeth. The bigger staining of CGRP, VEGF and TGFß in the animals with 14 days of ligature than those 7 days shows the evolution of the chronic inflammation process. We dont observe the process of tissue healing.

Migraine is a complex neurological disorder that affects approximately 38 million Americans. For over 25 years, the neuropeptide calcitonin gene-related peptide (CGRP) has been implicated in the pathogenesis of migraine. In fact, several pharmaceutical companies are tailoring treatments to antagonize CGRP actions. However, due to the complexity of migraine, exactly how and where CGRP acts to contribute to migraine have remained controversial: whereas several studies suggest that CGRP acts in the central nervous system (CNS) in this context, others have indicated a role in the periphery. Central nervous system sites of action include the trigeminal nucleus and several higher brain regions, and peripheral sites include the vasculature and dural mast cells in the meninges. Among the sites of CGRP action, the trigeminal nerve, which is the major somatosensory structure of the face, is of particular interest because it bridges the CNS and the periphery. Migraine is generally thought to involve abnormal signaling in the trigeminovascular system, and about 50% of trigeminal neurons have CGRP immunoreactivity. Although the notion that CGRP has a central site of action in relation to migraine had gained ground over the past decade, the recent discovery that monoclonal antibodies against CGRP can prevent migraine attacks has resurrected the possibility that a peripheral site of action is involved as well. Clarification of the sites of CGRP action in migraine will be crucial to developing an understanding of mechanisms that underlie migraine so that future treatments can be rationally designed. One diagnostic criterion for migraine is photophobia, a painful and often debilitating response to non-noxious levels of light. Our laboratory previously developed a preclinical model of migraine in which the light-aversive behavior of mice is used as a surrogate of photophobia. Specifically, mice were sensitized to CGRP by introducing a nestin/hRAMP1 transgene. In these mice versus control littermates, light aversion in response to central (intracerebroventricular, ICV) injection of CGRP was enhanced in dim light. In wild-type mice, CGRP (ICV) also elicited aversion to very bright light; this did not occur in vehicle-treated mice. Additionally, I have shown that CGRP injected peripherally (intraperitoneal, IP) can induce significant light aversion in wild-type mice. I have begun to identify the sites of action outside of the central nervous system, using four lines of transgenic mice with different patterns of overexpression of CGRP receptors: global hRAMP1 mice (expression in all tissues), nestin/hRAMP1 mice (expression only in nervous tissue), tagln/hRAMP1 (expression only in smooth muscle cells), and tek2/hRAMP1 (expression in endothelial cells). As predicted, in the global hRAMP mice light aversion, in response, to IP-injected CGRP was enhanced. However, in nestin/hRAMP1 mice, only ICV-injected, and not IP-injected, CGRP induced enhanced light aversion. This finding suggests that peripheral CGRP activates neural pathways involved in light aversion, but by an indirect mechanism. To determine where in the periphery CGRP is acting, a pharmacological and genetic approach was taken. Since CGRP is one of the most potent vasodilators in the body, it is well positioned to have vascular effects that induce light aversive behavior. This hypothesis was based on findings that 1) intravenous administration of CGRP in human subjects can cause migraine pain, and 2) perivascular CGRP can sensitize the trigeminal nerve, which could alter synaptic transmission to the central nervous system and 3) CGRP monoclonal antibodies are effective in clinical trial and likely do not cross the blood brain barrier. Thus, there is a mechanism by which CGRP in the periphery can sensitize the trigeminal nerve and alter sensory perception, leading to photophobia. The role of the vasculature in migraine, specifically vasodilation, has been controversial and now the consensus is that it is neither necessary nor sufficient. First, I wanted to test the role of vasodilation in this model. I pharmacologically inhibited CGRP-induced vasodilation using two vasoconstrictors, phenylephrine and endothelin-1. Blocking CGRP-induced vasodilation partially attenuates the light aversive response. Moreover, mice that overexpress the CGRP receptor in smooth muscle, but not endothelial, cells exhibit enhanced light aversion indicating a role for vascular actions of CGRP in this preclinical model of migraine. These results present clear evidence that CGRP has actions on the vasculature to induce light aversion. Additionally, the inability of blocking vasodilation to completely rescue the light aversion suggests that the vasculature may not be the only peripheral target of CGRP in migraine pathophysiology. This work improves the understanding of peripheral CGRP actions in migraine and raises awareness that contribution of the vasculature in migraine should not be ignored. The identification of sites of CGRP action in regions inside and outside of the CNS could lead to improved and more successful therapeutics for migraine.

Calcitonin gene-related peptide (CGRP) has been strongly implicated in the pathophysiology of migraine. CGRP levels are elevated during a migraine attack. Injection of CGRP can trigger a delayed migraine-like headache in migraineurs. Finally, CGRP receptor antagonists are effective antimigraine therapeutics. Consequently, a CGRP-sensitized mouse, nestin/hRAMP1 was genetically engineered to conditionally express a subunit of the CGRP receptor, hRAMP1, in neurons and glia. In response to CGRP, nestin/hRAMP1 mice demonstrated a significant decrease in time in the light zone of a dim light-dark box compared to vehicle-treated nestin/hRAMP1 mice and CGRP-treated control mice. This reflects photophobia-like behavior. Photophobia is a common symptom of migraine, where light exacerbates the headache pain. Furthermore, CGRP decreased motility in the dark zone, which may reflect exacerbation of pain by movement that is often experienced during a migraine. Wildtype mice have also demonstrated this CGRP-induced behavior, but required bright light and habituation to the chamber. While there is a difference in sensitivity in this assay between wildtype and nestin/hRAMP1 mice, it demonstrates that endogenous CGRP receptors are sufficient to convey this behavior. A common antimigraine drug, rizatriptan, attenuated the CGRP-induced behaviors in wildtype mice validating the assay as a migraine model. To explore the relative contributions of CGRP receptors on neurons versus glia, synapsin/hRAMP1 transgenic mice were genetically engineered to express hRAMP1 in neurons only. In contrast to the nestin/hRAMP1 mice, the synapsin/hRAMP1 mice did not show CGRP-induced light aversion upon naïve exposure to a dim chamber. This suggests that neuronal overexpression of hRAMP1 is insufficient to convey a heighted sensitivity to CGRP in the light aversion assay. As a first step to understanding the mechanism underlying CGRP-induced light aversion, a non-behavioral assay was developed to measure photic blink reflexes by measuring orbicularis oculi EMG responses in mice. Bright light increased orbicularis oculi activity, and an air puff induced a blink response. Interestingly. CGRP and bright light increased the duration of squinting following the air puff-induced blink. This pilot suggests that the trigeminal system plays a key role in mediating CGRP-induced light sensitivity. Overall, these studies propose a potential model for the mechanisms involved in migraine and photophobia in which CGRP likely acts through endogenous CGRP receptors on neurons and glia in the trigeminal system to trigger light sensitivity.

Studies have shown that long-term opioid agonist (such as morphine) treatment produces antinociceptive tolerance and increased pain sensitivity (hyperalgesia and/or allodynia), limiting the clinical efficacy of morphine. Prolonged opiate administration also upregulates spinal pain neurotransmitter (such as calcitonin gene-related peptide (CGRP)) levels and enhances evoked CGRP release in the dorsal horn of rats. It was suggested that augmented spinal pain neurotransmission may contribute to paradoxical pain sensitization and antinociceptive tolerance. The cellular signal transduction pathways involved in sustained opioid mediated augmentation of spinal pain neurotransmitter are not fully clarified.Sustained morphine treatment was shown to augment the concentrations of inflammatory mediators, such as PGE2 in the spinal cord. Studies have shown that PGE2 stimulates cAMP formation and CGRP release by activation of Gs protein-coupled prostaglandin receptor types in primary sensory neurons. Interestingly, it was found earlier that sustained opioid agonist treatment leads to a Raf-1-dependent sensitization of adenylyl cyclase(s) (AC superactivation), augmenting forskolin-stimulated cAMP formation upon opioid withdrawal (cAMP overshoot). It is well demonstrated that cAMP activates cAMP-dependent protein kinase (PKA), which plays an important role in the modulation of presynaptic neurotransmitter release. Therefore, in this study, we investigate the physiological role of Raf-1 mediated AC superactivation and subsequent PKA activation in A. sustained morphine-mediated augmentation of basal or evoked pain neurotransmitter release in vitro, in cultured primary sensory neurons, and B. in vivo, in sustained morphine mediated paradoxical pain sensitization and antinociceptive tolerance in rats.Our data demonstrates that A. sustained morphine treatment augments both basal and capsaicin-evoked CGRP release from isolated primary sensory neurons in a PKA- and Raf-1- dependent manner. B. sustained morphine treatment- augments of PGE2-evoked CGRP release from these cells. C. selective knockdown of spinal PKA or Raf-1 protein levels by intrathecal PKA- or Raf-1-specific siRNA pretreatment completely attenuates sustained morphine-mediated thermal hyperalgesia, tactile allodynia and greatly reduces antinociceptive tolerance in rats.In conclusion, we suggest that Raf-1-mediated AC superactivation may have a crucial trigger role in sustained morphine-mediated compensatory adaptations in the nervous system. Thus, we expect that pharmacological attenuation of Raf-1-mediated AC superactivation may improve the clinical treatment of chronic and neuropathic pain.

The murine model has been used to investigate the role of cardiac sensory axons in various disease states. However, the distribution and morphological structures of cardiac nociceptive axons in normal murine tissues have not yet been well characterized. In this study, whole-mount atria from FVB mice were processed with calcitonin gene-related peptide (CGRP) and substance P (SP) primary antibodies followed by secondary antibodies, and then examined using confocal microscopy. We found: 1) Large CGRP-IR axon bundles entered the atria with the major veins, and these large bundles bifurcated into small bundles and single axons that formed terminal end-nets and free endings in the epicardium. Varicose CGRP-IR axons had close contacts with muscle fibers, and some CGRP-IR axons formed varicosities around principle neurons (PNs) within intrinsic cardiac ganglia (ICGs). 2) SP-IR axons also were found in the same regions of the atria, attached to veins, and within cardiac ganglia. Similar to CGRP-IR axons, these SP-IR axons formed terminal end-nets and free endings in the atrial epicardium and myocardium. Within ICGs, SP-IR axons formed varicose endings around PNs. However, SP-IR nerve fibers were less abundant than CGRP-IR fibers in the atria. 3) None of the PNs were CGRP-IR or SP-IR. 4) CGRP-IR and SP-IR often colocalized in terminal varicosities around PNs. Collectively, our data document the distribution pattern and morphology of CGRP-IR and SP-IR axons and terminals in different regions of the atria. This knowledge provides useful information for CGRP-IR and SP-IR axons that can be referred to in future studies of pathological remodeling.

No description available.

La ciguatéra est une forme d’intoxication faisant suite à l’ingestion de poissons contaminés par des toxines appelées « ciguatoxines ». Cette intoxication endémique des régions tropicales est un problème économique et de santé non négligeable qui tend à prendre de plus en plus d’ampleur. L’essor du tourisme, le réchauffement climatique et la hausse des exportations internationales de poissons tropicaux favorisent l’expansion de la ciguatéra aux parties du globe au climat tempéré, jusqu’alors peu concernées par cette maladie. Les enjeux thérapeutiques et économiques de la ciguatéra sont de taille puisqu’il n’existe aucun moyen rapide et fiable de détecter un poisson contaminé et qu’aucun traitement efficace permettant sa prise en charge n’a actuellement été établi.Le prurit, terme médical désignant les démangeaisons est un symptôme notamment associé aux maladies de peau qui impacte grandement la qualité de vie des patients qui en souffrent.Ces dernières décennies, de nombreuses études scientifiques ont permis de mieux comprendre sa physiopathologie. Le prurit est un symptôme fréquemment observé chez les personnes atteintes de ciguatéra, d’où l’appellation « la Gratte », souvent employée pour faire référence à la pathologie.Dans le but d’étudier les mécanismes cellulaires à l’origine du prurit et des autres troubles sensoriels cutanés survenant lors de la ciguatéra, nous avons étudié l’effet des ciguatoxines sur un modèle in vitro de neurones sensoriels cocultivés avec des kératinocytes. Nous avons mis en évidence la libération dans le surnageant des neuropeptides de l'inflammation neurogène, SP et CGRP. L'effet d'antagonistes sélectionnés a été testé afin mettre en évidence les médiateurs impliqués dans la libération de neuropeptides. Par ailleurs, la signalisation cellulaire sous-jacente de cette sécrétion de neuropeptides a été étudiée par des expériences d’imagerie calcique réalisées sur neurones et kératinocytes.Les résultats obtenus valident notre coculture en tant que modèle de choix pour l’étude in vitro des mécanismes cellulaires, et plus généralement, dans les troubles neurocutanés impliqués dans le prurit ciguatérique. Parmi les antagonistes testés, une molécule s’est avérée particulièrement intéressante pour inhiber les effets constatés de la toxine. Ces résultats originaux, obtenus avec l’antagoniste d’un médiateur du prurit, présentent une perspective thérapeutique nouvelle et prometteuse, pour répondre à un enjeu de santé publique futur. / Ciguatera fish poisoning (CFP) is a seafood poisoning occurring after contaminated fish fleshes ingestion containing toxins called « ciguatoxines » (CTXs). This illness, originating from tropical and subtropical areas, is an economic and health problems which becomes substantial in relation to international tropical fishes export and tourism development, as well as global warming rise. Those factors contribute to CFP sprouting in non-endemic temperate climate regions which were not until then concerned by CFP. Economic and health stakes of CFP are important since no reliable and ready-to-use detection system for CTXs in fishes have been developed, along with no relevant cure has been established to treat CFP.Pruritus, medical term refer to itch, is a clinical sign usually associated to skin diseases which strongly alter patients’ quality of life. Last decades, several studies allowed to better understand pruritus pathophysiology. Interestingly, people suffering from CFP frequently present pruritus, hence designation “La Gratte” or “La Gratel (le)” employed in endemic areas.The aim of these works was to study cellular and molecular mechanisms of CTXs at the root of neurological cutaneous troubles occurring in CFP. Here, we evaluated CTXs effects on in vitro model composed of sensory neurons cocultived with primary keratinocytes, quantifying neuropeptides known to be involved in pruritus. Compiling knowledges about CFP and pruritus pathophysiology, some antagonists were tested to neutralize CTXs-mediated neuropeptide release. To deal with signaling pathways in depth of neuropeptide exocytosis induced by CTXs, mechanism known to be accurately regulated by calcium homeostasis, calcium imaging experiments were performed.Results obtained in this project confirm the use of such a model to elucidate cellular mechanism of CFP pruritus, but also constitute an alternative in vitro tool to study chemicals inducing abnormal cutaneous senses. Among antagonists tested, one stands out from the crowd and was proved to be effective to inhibit CTXs-evoked effects studied. Those originals results, collected with antagonist of pruritus mediator, show new and promiscuous therapeutic prospects for future health concern.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Gout is a prevalent form of inflammatory arthritis, which leads to patients poor quality of life. Acute gout attacks produce severe joint pain and inflammation associated with oxidative stress induction. This pathology is provoked by the accumulation of monosodium urate (MSU) crystals, but the underlying pain mechanisms in acute gout attacks are still poorly understood. The transient potential receptor ankyrin 1 (TRPA1) is a sensor for endogenous oxidant compounds, such as hydrogen peroxide (H2O2), found in peptidergic sensory fibers associated to inflammatory pain. The goal of this study was to explore the TRPA1 role in two models of monosodium urate (MSU) crystals-induced inflammation and nociception in rats and mice. We found that TRPA1 antagonism (HC-030031 or camphor), TRPA1 gene deletion or defunctionalization by capsaicin pretreatment of peptidergic TRPexpressing primary sensory neurons markedly decreased MSU-induced nociception and edema after intraplantar (i.pl.) or intra-articular (i.a.) injection. In addition to these neurogenic effects, MSU increased H2O2 levels in the injected tissue, an effect that was abolished by the H2O2-detoxifing, catalase enzyme. TRPA1 immunoreactivity in sciatic nerve and the levels of calcitonin gene related peptide (CGRP) in the synovial tissue were also increased by MSU. H2O2 i.pl. or i.a. injection mimicked MSU, causing nociception and edema prevented by TRPA1 antagonism. Moreover, TRPA1 blockage abrogated the increase in neutrophil infiltration and interleukin-1β elicited by MSU. Our results suggest that MSU-injection increases tissue H2O2 thereby stimulating TRPA1 on sensory nerve endings to produce inflammation and nociception. Thus, TRPA1 may be explored as a valuable target in acute gout management. / A gota é uma forma prevalente de artrite inflamatória que reduz a qualidade de vida dos pacientes. Os ataques agudos de gota produzem dor articular grave e inflamação que são associadas à produção de estresse oxidativo. Esta patologia é provocada pela deposição de cristais de urato monossódico (MSU), mas os mecanismos relacionados à dor observada nos ataques agudos de gota ainda são pouco esclarecidos. O receptor de potencial transitório anquirina 1 (TRPA1) é um sensor para compostos oxidantes, como o peróxido de hidrogênio (H2O2), encontrado em fibras sensoriais peptidérgicas e este está relacionado ao desenvolvimento de dor inflamatória. O objetivo deste estudo foi avaliar o papel do receptor TRPA1 em dois modelos de inflamação e nocicepção induzidos pela administração de cristais de MSU em ratos e camundongos. Observamos que o antagonismo do receptor TRPA1 (HC-030031 ou cânfora), a deleção genética deste canal, ou ainda a indução de dessensibilização dos neurônios sensoriais que expressam os receptores TRP pelo tratamento com capsaicina reduziram marcantemente a nocicepção e edema induzido pela administração intraplantar (i.pl.) ou intra-articular (i.a.) dos cristais de MSU. Além destes efeitos neurogênicos a administração de MSU aumentou o conteúdo de H2O2 nos tecidos injetados, um efeito que foi bloqueado pela enzima catalase, e também aumentou a imunoreatividade para o receptor TRPA1 no nervo ciático e no tecido sinovial, e também os níveis do peptídeo relacionado ao gene da calcitonina (CGRP) no tecido sinovial. A administração de H2O2 por via i.pl. ou i.a. induziu efeitos semelhantes àqueles induzidos pela administração de MSU, e estes foram reduzidos pela administração de antagonistas TRPA1. Ainda, o bloqueio do receptor TRPA1 reduziu a infiltração de neutrófilos e a produção de interleucina 1β induzidas pela administração de cristais de MSU. Em conclusão, os nossos resultados sugerem que a administração dos cristais de MSU é capaz de aumentar a produção de H2O2 que então poderia estimular o receptor TRPA1 expresso em neurônios sensoriais causando nocicepção e inflamação dos tecidos. Dessa maneira, o canal TRPA1 poderia ser explorado como um alvo em potencial para o tratamento dos ataques agudos de gota.

Background: Migraine is a common disease with a global prevalence of about 15%. Migraine is divided into two main types; migraine with aura or migraine without aura. Migraine symptoms include moderate or severe unilateral pulsating pain exacerbated by physical activity, nausea and vomiting as well as light and sound sensitivity. Headaches lasting ≥ 15 days per month of which ≥ 8 of the days are migraine are defined as chronic migraine. Episodic migraine is defined as less than 15 headache days per month. The full reasons for how and why migraine arises are not yet fully understood. The main hypothesis is that migraine is due to a hypersensitivity in the brain that involves activating and sensitizing the trigeminovascular system. Calcitonine-related peptide (CGRP) has been shown to be an important neurotransmitter in the pathophysiology of migraine that mediates pain through vasodilation of intracranial vessels and an increased sensitivity of A-δ fibers. New drugs in the form of monoclonal antibodies directed against CGRP or the CGRP receptor have been developed to try to stop the CGRP signaling. Currently, there are four approved drugs: galcanezumab, fermanezumab and eptinezumab, which are three monoclonal antibodies directed against CGRP and erenumab which is a monoclonal antibody directed against the CGRP receptor. Purpose: The purpose of this literature study was to investigate how effective treatment with the monoclonal antibodies erenumab, fremanezumab, galcanezumab and eptinezumab directed against CGRP or the CGRP receptor is as prophylaxis against episodic and chronic migraine versus placebo. Method: A literature study was performed by reviewing articles retrieved from the Pubmed database. A free text search was done in Pubmed with the keywords "fremanezumab" OR "eptinezumab" OR "galcanezumab" OR "erenumab". The studies should be randomized, double-blind and placebo-controlled with the aim of investigating the efficacy and tolerability of treatment with erenumab, fremanezumab, galcanezumab or erenumab. A total of eight studies were selected for review. Results: Two studies reviewed erenumab, three studies reviewed fremanezumab, two studies reviewed galcanezumab and one study reviewed eptinezumab. The results showed that all four substances significantly reduced the number of migraine days per month compared to placebo with a mean change of −2.1. Number needed to treat (NNT) to produce ≥ 50 % reduction in migraine frequency varied between 4 – 33 in the eight studies. Conclusion: The results of the eight studies showed that treatment with erenumab, fremanezumab, galcanezumab or eptinezumab in patients with chronic and episodic migraine significantly reduce the number of migraine days per month compared to placebo. The treatments have been well tolerated and there have been relatively few side effects that have been comparable to placebo. However, more long-term studies need to be done to detect any long-term side effects.

Migraine is one of the most prevalent contributors to the global burden of mental and neurological disorders. It is a complex episodic condition that presents as intense recurrent unilateral headaches lasting hours to days that can be accompanied by nausea, photophobia, phonophobia and other neurological symptoms. The causes of migraine appear multifactorial and are not fully understood. However, activation of the trigeminovascular system and sphenopalatine parasympathetic neurons and the resulting vasodilation of meningeal arteries have been associated with the development of migraine pain. Recently, the neurotransmitter and neurotrophic peptide pituitary adenylate cyclase activating polypeptide (PACAP) has been implicated in this migraine headache pathway. The effects of PACAP parallel those of other migraine inducing agents and notably PACAP induces vasodilation of the MMA concurrent with the genesis of migraine headache when administered to human subjects. The mechanisms by which PACAP induces dilation are presently unclear. The objective of this present work was to elucidate the signaling pathways linking PACAP to MMA dilation. To achieve this objective, we developed an ex vivo approach to study isolated MMA at physiologically relevant intravascular pressure. Using this preparation we found that PACAP dilates MMA at picomolar concentrations via PAC1 receptors. Further, in MMA, PACAP-induced dilation is mediated exclusively though activation of KATP channels. While investigating the mechanisms of PACAP-induced dilation of MMA we discovered that basal KATP channel activity influences MMA diameter. Inhibition of KATP channels with glibenclamide or PNU37883 at physiological intravascular pressure resulted in a vasoconstriction of ≈ 20 %. Also consistent with basal KATP activity, glibenclamide induced a membrane potential depolarization of ≈ 14 mV. Further, in MMA loaded with the ratiometric Ca2+ indicator, Fura-2-AM, glibenclamide-induced MMA constriction was correlated with a simultaneous increase in the ratio of 340 nm/380 nm excited fura-2 fluorescence, consistent with an increase in intracellular Ca2+. Vascular smooth muscle KATP channels can be phosphorylated and activated by PKA, resulting in membrane potential hyperpolarization. KT5720, a PKA inhibitor, induced a constriction in MMA similar to that of glibenclamide (≈ 25 %). Additional treatment with glibenclamide did not induce further constriction suggesting that PKA activity may underlie tonic KATP channel activation. Together these results suggest that tonic PKA activity underlies basal KATP channel activity and together play a key role in regulation of MMA diameter. In summary, results presented in this dissertation suggest that picomolar PACAP-induced dilation of MMA is via activation of the PAC1-Hop1 receptor splice variant and KATP channel activation. Furthermore, KATP channels are also involved in tonic regulation of MMA diameter due to basal PKA activity. These unique features of the MMA provide additional insight into potential therapeutic targets in the development of treatments for migraine.