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偏头痛的分子伤害感受机制:偏头痛级联反应。

Molecular nociceptive mechanisms in migraine: The migraine cascade.

机构信息

Danish Headache Center, Department of Neurology, Translational Research Center, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark.

Department of Neurology, Zealand University Hospital, Roskilde, Denmark.

出版信息

Eur J Neurol. 2024 Aug;31(8):e16333. doi: 10.1111/ene.16333. Epub 2024 Jun 18.


DOI:10.1111/ene.16333
PMID:38894592
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11235602/
Abstract

OBJECTIVE: This review will explore the categorization of migraine-provoking molecules, their cellular actions, site of action and potential drug targets based on the migraine cascade model. METHODS: Personal experience and literature. RESULTS: Migraine impacts over 1 billion people worldwide but is underfunded in research. Recent progress, particularly through the human and animal provocation model, has deepened our understanding of its mechanisms. This model have identified endogenous neuropeptides such as calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating peptide (PACAP) that induces controlled migraine-like attacks leading to significant discoveries of their role in migraine. This knowledge led to the development of CGRP-inhibiting drugs; a groundbreaking migraine treatment now accessible globally. Also a PACAP-inhibiting drug was effective in a recent phase II trial. Notably, rodent studies have shed light on pain pathways and the mechanisms of various migraine-inducing substances identifying novel drug targets. This is primarily done by using selective inhibitors that target specific signaling pathways of the known migraine triggers leading to the hypothesized cellular cascade model of migraine. CONCLUSION: The model of migraine presents numerous opportunities for innovative drug development. The future of new migraine treatments is limited only by the investment from pharmaceutical companies.

摘要

目的:本综述将根据偏头痛级联模型,探讨偏头痛诱发分子的分类、细胞作用、作用部位和潜在的药物靶点。

方法:个人经验和文献。

结果:偏头痛影响着全球超过 10 亿人,但在研究方面资金投入不足。最近的进展,特别是通过人类和动物诱发模型,加深了我们对其机制的理解。该模型已确定了内源性神经肽,如降钙素基因相关肽(CGRP)和垂体腺苷酸环化酶激活肽(PACAP),它们引发可控的偏头痛样发作,从而对其在偏头痛中的作用有了重大发现。这一知识促成了 CGRP 抑制剂药物的开发;一种突破性的偏头痛治疗方法现在在全球范围内都可以获得。此外,一种 PACAP 抑制剂药物在最近的 II 期临床试验中也有效。值得注意的是,啮齿动物研究揭示了疼痛途径和各种诱发偏头痛物质的机制,确定了新的药物靶点。这主要是通过使用选择性抑制剂来靶向已知偏头痛触发物的特定信号通路,从而导致假设的偏头痛细胞级联模型。

结论:偏头痛模型为创新药物开发提供了众多机会。新的偏头痛治疗方法的未来仅受制药公司投资的限制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/874a/11235602/33d2b7889050/ENE-31-e16333-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/874a/11235602/08a9bd72ba4b/ENE-31-e16333-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/874a/11235602/3fe683444542/ENE-31-e16333-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/874a/11235602/75df37cb676c/ENE-31-e16333-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/874a/11235602/33d2b7889050/ENE-31-e16333-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/874a/11235602/08a9bd72ba4b/ENE-31-e16333-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/874a/11235602/3fe683444542/ENE-31-e16333-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/874a/11235602/75df37cb676c/ENE-31-e16333-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/874a/11235602/33d2b7889050/ENE-31-e16333-g002.jpg

相似文献

[1]
Molecular nociceptive mechanisms in migraine: The migraine cascade.

Eur J Neurol. 2024-8

[2]
Role of PACAP in migraine: An alternative to CGRP?

Neurobiol Dis. 2023-1

[3]
Dynamic changes in CGRP, PACAP, and PACAP receptors in the trigeminovascular system of a novel repetitive electrical stimulation rat model: Relevant to migraine.

Mol Pain. 2019

[4]
Future targets for migraine treatment beyond CGRP.

J Headache Pain. 2023-6-28

[5]
PACAP Induces Light Aversion in Mice by an Inheritable Mechanism Independent of CGRP.

J Neurosci. 2021-5-26

[6]
Shared and independent roles of CGRP and PACAP in migraine pathophysiology.

J Headache Pain. 2023-4-3

[7]
From CGRP to PACAP, VIP, and Beyond: Unraveling the Next Chapters in Migraine Treatment.

Cells. 2023-11-17

[8]
Expression of Pituitary Adenylate Cyclase-activating Peptide, Calcitonin Gene-related Peptide and Headache Targets in the Trigeminal Ganglia of Rats and Humans.

Neuroscience. 2018-10-15

[9]
Calcitonin/PAC receptor splice variants: a blind spot in migraine research.

Trends Pharmacol Sci. 2023-10

[10]
Calcitonin gene-related peptide and pituitary adenylate cyclase-activating polypeptide in migraine treatment.

Curr Opin Endocrinol Diabetes Obes. 2022-4-1

引用本文的文献

[1]
The mysterious link between migraine aura and migraine headache.

PLoS Biol. 2025-6-11

[2]
Cerebral blood flow and arterial responses in migraine: history and future perspectives.

J Headache Pain. 2024-12-19

[3]
KCNG4 Genetic Variant Linked to Migraine Prevents Expression of KCNB1.

Int J Mol Sci. 2024-8-17

本文引用的文献

[1]
Second messenger signalling bypasses CGRP receptor blockade to provoke migraine attacks in humans.

Brain. 2023-12-1

[2]
PACAP signaling is not involved in GTN- and levcromakalim-induced hypersensitivity in mouse models of migraine.

J Headache Pain. 2022-12-5

[3]
Localization of the neuropeptides pituitary adenylate cyclase-activating polypeptide, vasoactive intestinal peptide, and their receptors in the basal brain blood vessels and trigeminal ganglion of the mouse CNS; an immunohistochemical study.

Front Neuroanat. 2022-10-26

[4]
Personal view: Modelling pain mechanisms of migraine without aura.

Cephalalgia. 2022-11

[5]
The PACAP pathway is independent of CGRP in mouse models of migraine: possible new drug target?

Brain. 2022-7-29

[6]
Smooth muscle ATP-sensitive potassium channels mediate migraine-relevant hypersensitivity in mouse models.

Cephalalgia. 2022-2

[7]
CGRP-dependent signalling pathways involved in mouse models of GTN- cilostazol- and levcromakalim-induced migraine.

Cephalalgia. 2021-12

[8]
Opening of BKCa channels causes migraine attacks: a new downstream target for the treatment of migraine.

Pain. 2021-10-1

[9]
Effects of Intravenous Eptinezumab vs Placebo on Headache Pain and Most Bothersome Symptom When Initiated During a Migraine Attack: A Randomized Clinical Trial.

JAMA. 2021-6-15

[10]
PACAP Induces Light Aversion in Mice by an Inheritable Mechanism Independent of CGRP.

J Neurosci. 2021-5-26

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