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Indian Journal of Pharmacology
Medknow Publications on behalf of Indian Pharmacological Society
ISSN: 0253-7613 EISSN: 1998-3751
Vol. 36, Num. 5, 2004, pp. 277-283
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Indian Journal of Pharmacology, Vol. 36, No. 5, October, 2004, pp. 277-283
Education Forum
Calcitonin gene-related peptide: Understanding its role
Ghatta Srinivas, Nimmagadda D
Department of Pharmaceutical Sciences, College of Pharmacy, North Dakota State University, Fargo ND 58105
Correspondence Address:Department of Pharmaceutical Sciences,
College of Pharmacy, North Dakota State University, Fargo ND 58105 srinivas.ghatta@ndsu.nodak.edu
Code Number: ph04097
ABSTRACT
Calcitonin gene-related peptide (CGRP), a 37 amino acid neuropeptide, identified
in multiple species, has widespread distribution and expression. CGRP acts
through G protein-coupled receptors whose presence and changes in function
modulate the peptide's effects in various tissues. Three receptor subtypes
have been identified and CGRP's signal transduction through the receptors
is dependent on two accessory proteins: Receptor activity modifying protein1
(RAMP1) and Receptor component protein (RCP). Several endogenous substances
such as glucocorticoids, nitric oxide (NO), nerve growth factors (NGF),
and steroid hormones modulate CGRP release and synthesis. Both peptide
and non-peptide agonists and antagonists of CGRP receptors are being developed.
Also the therapeutic benefits of some antagonists such as BIBN 4096 BS
in migraine have been promising. This brief review provides a preliminary
understanding of the diverse biological effects of the peptide in various
systems. The current status of CGRP and its receptors in many pathophysiological
states is not fully explored and future findings are greatly awaited.
Key Words: Calcitonin-receptor like receptor, CGRP
receptor, cAMP, signal transduction
INTRODUCTION
Calcitonin gene-related peptide (CGRP), identified in 1982, belongs to
the calcitonin family of neuropeptides which also includes adrenomedullin,
amylin, calcitonin, intermedin and calcitonin receptor-stimulating peptide.
CGRP results from the tissue-specific alternative splicing of the
primary RNA transcripts of the calcitonin gene. It is a 37 amino acid neuropeptide
([Figure - 1]) with widespread
expression such as in the heart, blood vessels, pituitary, thyroid, lung,
gastrointestinal tract and a wide array of biological effects including
neuromodulation, vasodilatation, cardiac contractility, bone growth, and
mammalian development. The peptide is released from motor neurons at the
neuromuscular junction and sensory neurons of spinal cord. There are two
isoforms available: aCGRP and ßCGRP[1] which
are derived from different genes. ßCGRP differs from aCGRP
by three amino acids in rats and by one in humans. ßCGRP is mainly
present in the enteric nervous system whereas aCGRP
is present in the sensory neurons. No major
differences in the effects between a and ßCGRP
with respect to adenylyl cyclase stimulation and intracellular cAMP formation
are found. Potent
subtype
selective non-peptide agonists and antagonists for CGRP are being developed
for therapeutic use in hypertension, cardiac failure, migraine headaches,
Reynaud′s syndrome, preeclampsia, and diabetes.[2] The
main goal of this review is to summarize recent findings with respect to
CGRP, from its physiology and signal transduction to its pharmacological
aspects in various systems. The reader is suggested to look into similar
reviews for additional information.[3],[4],[5]
CGRP receptors
Therapeutic targeting of CGRP has always been a hindrance due to the
presence of multi components of its receptor. Cell surface receptor for
CGRP has been cloned recently and it is found to contain two components.
A seven transmembrane protein, calcitonin receptor-like receptor (CRLR)
belonging to the B family of G protein-coupled receptors (GPCRs) has
been identified as the receptor for CGRP ([Figure
- 2]).
It has a long extracellular N-terminus and a short intracellular C-terminus.
However, when transfected into COS-7 cells it was found out that CRLR
alone could not act as the functional receptor. An accessory protein,
receptor activity modifying protein 1 (RAMP1), acts as a chaperone for
CRLR, thus specifying the RAMP1+CRLR complete receptor complex.[6]
RAMPs are a three-member family of integral membrane proteins. They are
14-17 kDa single transmembrane domain polypeptides with a 100 amino acid
N-terminal extracellular domain and a short intracellular region. RAMP-1,
-2 and -3, have been identified in man, rat and mouse sharing a common
topology and ~60% similarity.
CGRP receptor component protein
(RCP), an intracellular peripheral membrane protein, is reported to couple
the receptor complex to the cellular signal transduction pathway.[7] It
is also known that heterodimeric RAMP2+CRLR is the defined adrenomedullin
receptor complex.[7] Recently,
a different CGRP receptor without any CRLR+RAMP1 has been expressed
in rat cerebellum and human embryonic kidney (HEK-293) cell lines. This
seven transmembrane receptor may be associated with RCP and it is speculated
that this receptor may be present in RCP-rich tissues where CRLR is not
expressed.[8]
Receptors for CGRP have been characterized in a variety of tissues
including pituitary, adrenal gland, heart and blood vessels. The comparative
potencies
of CGRP and its analogs in various in vitro and in vivo functional
assays have led to the suggestion of the existence of multiple classes
of CGRP receptors. Three subtypes of CGRP receptors have been reported.
Those are CGRP1, CGRP2 and CGRP3[9] and
the first two subtypes share pharmacological similarities. CGRP receptors
are classified based on their affinity for the truncated CGRP peptide,
CGRP8-37. pA2/pKB values of various
tissues in different species are mentioned in [Table
- 1].
Tissues having pA2 values 7.5-8.5 (high-affinity) are considered as CGRP1
and 5.5-6.5 (low-affinity) as CGRP2. But it is difficult to categorize
the tissues whose pA2 values are between 6.5 and 7.5.[10] Apparent
pKB values of BIBN 4096 BS for haCGRP and hßCGRP in
the left anterior descending coronary artery are, respectively, 8.0 and
6.6[4].
The effects of CGRP on the heart as well as on the blood vessels are
mediated through CGRP1. The relaxation induced by CGRP on the smooth
muscle such as the urinary bladder and vas deferens appears to be largely
mediated through the CGRP2 receptor subtype. Various novel non-peptide
CGRP1 receptor antagonists such as BIBN 4096 BS (a Lys-Tyr dipeptide
derivative), WO 98/11128 (Compound 1) and SB-273779[4] are
used as pharmacological tools to gain insights into CGRP receptor heterogeneity
in tissues. BIBN 4096 BS is a competitive reversible antagonist with
pKB 11. Reduction of the disulfide bond in CGRP, which destroys the N-terminal
ring structure of the peptide, yields a linear analog, diacetoamidomethyl
cysteine CGRP ([Cys (ACM)2,7] CGRP),
a selective agonist for CGRP2 receptors. CGRP (12-37), CGRP (19-37),
CGRP (28-37), [Tyr0] CGRP(27-37) are the other novel antagonists of
the CGRP1 receptor.[11]
Signal transduction GPCRs interact with G proteins to initiate signal transduction. Activation of sensory cells by calcium influx releases CGRP and coupling of receptor complex to GaS results in increased cellular cAMP levels. Although not a receptor itself, RCP is reported to channel CRLR to the cell surface and couple the receptor to the cell-signaling pathway.[7] The function of RCP is not universal to all GPCR signaling but is limited to CGRP receptors only. Protein Kinase A (PKA) is activated by cAMP formed by adenylyl cyclase. PKA in turn causes activation of many transcription factors like c-JUN NH2-terminal protein kinase (JNK) and phosphorylation of other proteins such as cAMP responsive element binding protein (CREB).[33] PKA-mediated activation is limited not only to JNK but also to other kinases like extracellular signal-regulated kinase-1 (ERK-1) and p38 Mitogen-activated protein kinase (p38 MAPK).[34]
CGRP and its biological significance
CGRP receptors are present in a wide variety of tissues and are implicated
in several pathophysiological conditions. The activation of these receptors
mainly produces potent vasodilatation and smooth muscle relaxation. CGRP
receptors not only increase cAMP levels but also downregulate the expression
of acetylcholinesterase at transcription level.[35] In
vascular smooth muscle cells, elevated cAMP levels are observed during
the opening of potassium channels resulting in decreased vascular tone.[36] Recent
studies have shown that CGRP increases mRNA levels of a subunit of acetylcholine
receptor (AChR), which is mediated through PKA. Local administration
of CGRP activates AChR in the brain, which modulates sympathetic nervous
system actions.[37] The
main biological effects of CGRP on various systems are summarized in
the following sections.
Nervous system
CGRP is widely distributed in the brain suggesting its involvement
in sensory and motor systems. With the exception of the dorsal motor
nucleus of the vagus nerve, CGRP is reported to be present in all cranial
nuclei. CGRP binding sites are also observed in the olfactory system.
The presence of a cholinergic/CGRP vestibular system suggests the role
of CGRP in the processing of auditive information.[1] Immunohistochemical
studies showed the presence of RCP of CGRP receptors in the human trigemino-vascular
system where CGRP receptors are co-localized with 5-HT1B/1D receptors.[38] Elevated
CGRP levels in jugular venous blood correlate with the timing and severity
of migraine and cluster headaches.[39] This
might be due to the increased gene expression of CGRP by activated MAPK
pathways.[40] Sumatriptan,
a 5-HT1B/1D receptor agonist, is used to treat increased CGRP levels
in migraine.[32] It owes
its therapeutic activity solely to a presynaptic action inhibiting CGRP
release and therefore neurogenic inflammation. Recent clinical trials
in migraine patients have demonstrated higher rate of response to BIBN
4096 BS, a CGRP receptor antagonist. These trials identified BIBN 4096
BS as an effective agent in the acute treatment for migraine.[41]
Pulmonary system
In situ hybridization and immunohistochemistry revealed the
existence of CGRP in the pulmonary system.[42] Released
CGRP has the ability to degranulate mast cells and release various chemical
mediators triggering inflammatory cycle.[43] Nerve
fibers projecting into the airways and pulmonary neuroendocrine cells
release CGRP into lungs. In the airways, the peptide acts on bronchial
smooth muscle and submucosal glands to promote airflow obstruction and
hyperemia,[44] hence
it′s implication in bronchoconstriction. CGRP has a potent vasodilatory
effect in human pulmonary arteries and veins as evidenced by the presence
of its receptors in pulmonary artery endothelium.[45] It
has already been reported that these receptors play an important role
in pulmonary hypertension.[46] CGRP
causes a concentration-dependent relaxation of the pulmonary artery[45] and
also effectively dilates precontracted pulmonary arteries.[47] Certain
N-terminal CGRP components are useful in the treatment of hypoxic pulmonary
hypertension (HPH). Artery pressures elevated in HPH are lowered by the
CGRP interventions and this action has been shown to be mediated through
CGRP putative receptor and RAMP1. It is further reported that in isolated
rat lungs CGRP′s mitigating effect on hypoxic pulmonary vasoconstriction
could involve the suppression of pressor response to angiotensin II.[47] Studies
on the extent of CGRP accumulation in allergic conditions such as asthma
are under way and its potential role in regulating pulmonary vasculature
is being investigated.
Gastrointestinal system
CGRP receptors are present in the D-cells of the gastric mucosa demonstrating
control of secretion and production of somatostatin.[48] The
secreted somatostatin inhibits gastric acid secretion both directly and
indirectly. The gastrointestinal actions of CGRP are mainly mediated
by CGRP1 receptors. The inhibitory influences of CGRP on the gastrointestinal
tract result in decreased motility and contraction.[49] In
rats, CGRP regulates food intake through receptors present in CNS.[50] Following
central administration of ßCGRP in humans, inhibition of gastric motor
functions and suppression of acid secretion were noted. The peptidergic
innervations are altered in various gastrointestinal disease conditions.
In short the centrally induced gastro-protective effect of CGRP helps
in the maintenance of gastric mucosal homeostasis. CGRP receptors are
also present in the D-cells of the pancreas[52] and
the exogenous CGRP gene therapy has been shown to mitigate autoimmune
diabetes by suppressing reactive oxygen species.[53] It
is reported that in conscious rats, central administration of CGRP inhibited
basal pancreatic secretion, acting through an -adrenergic mechanism.[54] Also,
CGRP acts on the gut mucosal immune system as an immunomodulator. This
was supported by the presence of CGRP receptors on T and B lymphocytes.[51] CGRP
antagonists could be used as spasmolytics, antidiarrheal and antinociceptive
drugs in gastrointestinal diseases. The increase in gastric blood flow
by CGRP resulting in gastric protection may provide new drug targets
in the treatment of gastric ulcers.
Reproductive system
CGRP influences many stages of mammalian development by affecting
the function of female and male reproductive organs. It regulates blood
flow to the female reproductive organs, has a role in the innervations
of the uterus and aids in fetal growth and survival. CGRP receptors are
reported in human myometrium, uterus, and placenta.[55] It
is involved in uterine relaxation during pregnancy.[56] It
is suggested that the peptide is involved in maintaining the human myometrium
in quiescence during pregnancy by antagonizing the actions of uterine
stimulants like oxytocin, and a decrease in the CGRP receptors towards
the end of pregnancy aids in the initiation of labor. Downregulation
of the receptors at the end of term and in postpartum is evident in rats
also.[57] Increased receptor
number in pregnancy signifies its importance in the maintenance of normal
systemic hemodynamics in that condition.[58] It
is postulated that hormonal cycle has an influence in CGRP release and
its adaptor functions in pregnancy.[58] Progesterone
stimulates and estrogen inhibits the CGRP receptor expression in the
placenta.[57] These hormones
also modulate the effects of CGRP on blood pressure in pregnancy.[58] Postmenopausal
women have less plasma CGRP levels than normal due to vasomotor changes
and hormone replacement therapy (HRT) causes CGRP levels to return back
to basal values.[59] It
has been reported that CGRP plays an important role in sperm function
in mice.[60] CGRP′s
status in the human male reproductive system is still being studied though
it is reported to be present in the semen, prostate, and seminal vesicles.[60] New
ligands of the CGRP1 receptor have therapeutic relevance in conditions
such as hot flushes and premature labor.
Cardiovascular system
CGRP has various actions on the human cardiovascular system such
as control of peripheral vascular tone, potent vasorelaxation, increase
in rate and force of contraction of heart. Sensory nerve terminals
of capsaicin-sensitive C- and A- delta fibers release CGRP by chemical,
thermal and mechanical stimuli. Various factors such as glucocorticoids,
nerve growth factor, and vascular wall tension and sympathetic nervous
system at the local level modulate CGRP release. CGRP is present in
a
network of nerve fibers that surrounds the arteries as well as on the
smooth muscle membrane.[61] Because
of the dense perivascular network of the CGRP nerves, CGRP dilates
various vascular beds such as mesenteric, renal and hindquarter skeletal
muscles,
acting through an endothelium-dependent and independent mechanism.[62],[63] Autoradiography
studies reveal that CGRP receptors are present in specific sites in
the intima and media of the aorta, coronary arteries and heart valves.[64] It
is reported that endogenous aCGRP has no role in regulating basal vascular
tone under normal, resting conditions but exogenous administration
causes a marked relaxation of different regional vascular beds.[65] The
aortic endothelium of the rat seems to express the CGRP1 subtype, which
is sensitive to aCGRP, ßCGRP and CGRP8-37.[28] CGRP1
is predominant in small intramural coronary arteries of the rat.[15] Systemic
administration of CGRP decreases blood pressure in humans and animals
along with increased cardiac performance and blood supply to vital
organs.[66]
Besides vasodilatory activity at the vascular level, CGRP produces
positive inotropic and chronotropic actions of the heart in various
mammals. CGRP
receptor gene is highly expressed in the rat heart.[67] Some
ß-adrenoceptor blockers have the ability to release CGRP from cardiac
sensory neurons, which activates cardiac CGRP receptors.[68] CGRP1
receptors mediate increase in cell surface area through enhanced skeletal
-actin expression in hypertrophy of cardiac myocytes.[69] The
highest density of receptors is found in the bundle of His of the guinea-pig.[70] the
atrial myocardium has dense CGRP fibers, which upon stimulation releases
CGRP. This in turn increases L-type calcium channel current through
adenylyl cyclase-cAMP pathway resulting in increased atrial contraction.
The peptide
has also been shown to produce a positive contractile response in the
ventricular myocytes.[22] CGRP
produces tachycardia by reflex activation of the sympathetic nervous
system.[62] Both CGRP1
and CGRP2 receptors are implicated in the inotropic effect of atria
and ventricles[71],[72] in
all mammals except in dogs where the hemodynamic changes are not mediated
by CGRP1 receptors.[73] In
metabolic acidosis, CGRP receptors facilitate the deleterious effects
of acidic pH by decreasing contractility and relaxation of isolated
rat atria.[74] It has
a protective action on myocytes and endothelial cells.[75]
CGRP plays a role in the modulation of platelet function. CGRP inhibits
platelet aggregation by increasing the platelet cAMP concentration.
This antiplatelet activity is mediated by the activation of nitric
oxide synthase.[76] Elevated
levels of circulating CGRP levels have been noted in experimental and
clinical models of sepsis while that of increased mRNA for CGRP were
observed in all tissues in a hamster peritonitis model.[77] In
humans the upregulation of CGRP occurs as the sepsis progresses. It
is suggested that the small intestine is a major source of these elevated
CGRP levels.[78]
Nitroglycerin activates sensory nerve fibers to release CGRP and the
cardiovascular effects of nitroglycerin (vasorelaxation and cardioprotection)
are partly mediated by endogenous CGRP.[79] The
reductive species of NO, nitroxyl anion, increases CGRP but not cGMP.[80] In
rats, CGRP levels are decreased during nitrate tolerance but are restored
after NTG withdrawal. Endogenous CGRP plays an important role in the
development of nitrate tolerance in rat thoracic aorta.[81] Nitrate
tolerance is reversed by using N-Acetyl cysteine and captopril, which
is thought to be due to an increase in CGRP release.[82] CGRP
released by nitroglycerin plays a role in cardiac preconditioning which
also activates KATP channels. Exogenous CGRP prevents myocardial and
endothelial injury caused by ischemia.[83] Vascular
CGRP is cleaved at Gly-Leu peptide bond by vascular matrix metalloproteinase,
which abolishes its vasodilatory effect.[84] Acute
myocardial infarction is a condition where there is a demand for increased
cardiac output and vasodilatation. This suggests the potential benefits
of CGRP agonists in ischemia and congestive heart failure.
Other actions
CGRP receptors are present in synovial joints and mediate
various neural regulations in inflammatory responses.[85] In
kidneys, infusion of CGRP at low doses causes vasodilatation and
an increase in glomerular filtration rate, whereas high
doses cause diuresis.[86] CGRP
elevates body temperature in male rats and probably is involved in
hot flashes in men.[87] Increase
in body weight has been shown to be associated with decreases in
Bmax and affinity of CGRP for the receptor.[88] CGRP
is involved in skin and immune cell functions such as cell proliferation
and cytokinin production.[89]
CONCLUSION
CGRP receptor antagonists may prove beneficial in many prevalent diseases such as migraine, arthritis, temporomandibular-joint disorders, in which CGRP levels are elevated. Future research with respect to complete cloning of CGRP and its peptide receptors is greatly awaited in order to fully elucidate its role in various systems and pathophysiological conditions. It is necessary to develop highly potent and selective analogues that will permit further characterization and the functional role(s) of each of the CGRP receptor subtypes.
ACKNOWLEDGEMENTS
We sincerely acknowledge and thank Drs. Stephen T O′Rourke and Jonathan
J Sheng for expert suggestions in the preparation of this manuscript.
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