Calcitonin gene-related peptide

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calcitonin-related polypeptide alpha
Alt. symbolsCALC1
Other data
LocusChr. 11 p15.2
calcitonin-related polypeptide, beta
Alt. symbolsCALC2
Other data
LocusChr. 11 p14.2-p12

Calcitonin gene-related peptide (CGRP) is a member of the calcitonin family of peptides, which in humans exists in two forms, α-CGRP and β-CGRP. α-CGRP is a 37-amino acid peptide and is formed from the alternative splicing[1] of the calcitonin/CGRP gene located on chromosome 11. The less-studied β-CGRP differs in three amino acids (in humans) and is encoded in a separate gene in the same vicinity.[2]


CGRP is produced in both peripheral and central neurons.[3] It is a potent peptide vasodilator and can function in the transmission of nociception.[4][5] In the spinal cord, the function and expression of CGRP may differ depending on the location of synthesis. CGRP is derived mainly from the cell bodies of motor neurons when synthesized in the ventral horn of the spinal cord and may contribute to the regeneration of nervous tissue after injury. Conversely, CGRP is derived from dorsal root ganglion when synthesized in the dorsal horn of the spinal cord and may be linked to the transmission of pain.[6] In the trigeminal vascular system, the cell bodies on the trigeminal ganglion are the main source of CGRP. CGRP is thought to play a role in cardiovascular homeostasis and nociception.


CGRP mediates its effects through a heteromeric receptor composed of a G protein-coupled receptor called calcitonin receptor-like receptor (CALCRL) and a receptor activity-modifying protein (RAMP1).[7] CGRP receptors are found throughout the body, suggesting that the protein may modulate a variety of physiological functions in all major systems (e.g., respiratory, endocrine, gastrointestinal, immune, and cardiovascular).[8] The extracellular loop number 2 is fundamental for ligand induced activation, with key interactions of R274/Y278/D280/W283.[9]


Regulation of the calcitonin gene-related peptide (CGRP) gene is in part controlled by the expression of the mitogen-activated protein kinases (MAPK) signaling pathway,[10] cytokines such as TNFα [11] and iNOS.[12]

5HT1 receptor agonists, such as sumatriptan, increase intracellular calcium, which cause decreases in CGRP promoter activity.[10]


Increased levels of CGRP have been reported in migraine and temporomandibular joint disorder patients as well as a variety of other diseases such as cardiac failure, hypertension, and sepsis.[13][14][15][16][17][18]

There is mounting evidence to suggest that CGRP may be beneficial in preventing the development of hypertension and cardiovascular pathologies associated with hypertension.[19] Prophylactic therapy with calcitonin gene‐related peptides (CGRPs) may have unknown fertility consequences for women of child bearing age. This is of particular concern, as females (16.6%) are more genetically predisposed than males (7.5%) to endure this debilitative health condition.[20]

Preclinical evidence suggests that, during a migraine, activated primary sensory neurons (meningeal nociceptors) in the trigeminal ganglion release CGRP from their peripherally projecting nerve endings located within the meninges.[21] This CGRP then binds to and activates CGRP receptors located around meningeal vessels, causing vasodilation, mast cell degranulation, and plasma extravasation.[8][21][22][23] Human observations have further implicated the role of CGRP in the pathophysiology of migraine. Activation of primary sensory neurons in the trigeminal vascular system in humans can cause the release of CGRP. During some migraine attacks, increased concentrations of CGRP can be found in both saliva and plasma drawn from the external jugular vein.[8][21][22][23] Furthermore, intravenous administration of alpha-CGRP is able to induce headache in individuals susceptible to migraine.[24]


  1. Amara SG, Jonas V, Rosenfeld MG, Ong ES, Evans RM (July 1982). "Alternative RNA processing in calcitonin gene expression generates mRNAs encoding different polypeptide products". Nature. 298 (5871): 240–4. doi:10.1038/298240a0. PMID 6283379.
  2. Rezaeian AH, Isokane T, Nishibori M, Chiba M, Hiraiwa N, Yoshizawa M, Yasue H (October 2009). "alphaCGRP and betaCGRP transcript amount in mouse tissues of various developmental stages and their tissue expression sites". Brain & Development. 31 (9): 682–93. doi:10.1016/j.braindev.2008.10.011. PMID 19062206.
  3. Rosenfeld MG, Mermod JJ, Amara SG, Swanson LW, Sawchenko PE, Rivier J, Vale WW, Evans RM (1983). "Production of a novel neuropeptide encoded by the calcitonin gene via tissue-specific RNA processing". Nature. 304 (5922): 129–35. doi:10.1038/304129a0. PMID 6346105.
  4. Brain SD, Williams TJ, Tippins JR, Morris HR, MacIntyre I (1985). "Calcitonin gene-related peptide is a potent vasodilator". Nature. 313 (5997): 54–6. doi:10.1038/313054a0. PMID 3917554.
  5. McCulloch J, Uddman R, Kingman TA, Edvinsson L (August 1986). "Calcitonin gene-related peptide: functional role in cerebrovascular regulation". Proceedings of the National Academy of Sciences of the United States of America. 83 (15): 5731–5. doi:10.1073/pnas.83.15.5731. PMC 386363. PMID 3488550.
  6. Chen LJ, Zhang FG, Li J, Song HX, Zhou LB, Yao BC, Li F, Li WC (January 2010). "Expression of calcitonin gene-related peptide in anterior and posterior horns of the spinal cord after brachial plexus injury". Journal of Clinical Neuroscience. 17 (1): 87–91. doi:10.1016/j.jocn.2009.03.042. PMID 19969463.
  7. Poyner DR, Sexton PM, Marshall I, Smith DM, Quirion R, Born W, Muff R, Fischer JA, Foord SM (June 2002). "International Union of Pharmacology. XXXII. The mammalian calcitonin gene-related peptides, adrenomedullin, amylin, and calcitonin receptors". Pharmacological Reviews. 54 (2): 233–46. doi:10.1124/pr.54.2.233. PMID 12037140.
  8. 8.0 8.1 8.2 Arulmani U, Maassenvandenbrink A, Villalón CM, Saxena PR (October 2004). "Calcitonin gene-related peptide and its role in migraine pathophysiology". European Journal of Pharmacology. 500 (1–3): 315–30. doi:10.1016/j.ejphar.2004.07.035. PMID 15464043.
  9. Woolley MJ, Simms J, Mobarec JC, Reynolds CA, Poyner DR, Conner AC (October 2017). "Understanding the molecular functions of the second extracellular loop (ECL2) of the calcitonin gene-related peptide (CGRP) receptor using a comprehensive mutagenesis approach". Molecular and Cellular Endocrinology. 454: 39–49. doi:10.1016/j.mce.2017.05.034. PMID 28572046.
  10. 10.0 10.1 Durham PL, Russo AF (February 2003). "Stimulation of the calcitonin gene-related peptide enhancer by mitogen-activated protein kinases and repression by an antimigraine drug in trigeminal ganglia neurons". The Journal of Neuroscience. 23 (3): 807–15. PMID 12574409.
  11. Schäfers M, Svensson CI, Sommer C, Sorkin LS (April 2003). "Tumor necrosis factor-alpha induces mechanical allodynia after spinal nerve ligation by activation of p38 MAPK in primary sensory neurons". The Journal of Neuroscience. 23 (7): 2517–21. PMID 12684435.
  12. Li J, Vause CV, Durham PL (February 2008). "Calcitonin gene-related peptide stimulation of nitric oxide synthesis and release from trigeminal ganglion glial cells". Brain Research. 1196: 22–32. doi:10.1016/j.brainres.2007.12.028. PMC 2268710. PMID 18221935.
  13. Buzzi MG, Bonamini M, Moskowitz MA (1995). "Neurogenic model of migraine". Cephalalgia. 15 (4): 277–80. doi:10.1046/j.1468-2982.1995.1504277.x. PMID 7585923.
  14. Goto K, Miyauchi T, Homma S, Ohshima N (June 1992). "Calcitonin gene-related peptide in the regulation of cardiac function". Annals of the New York Academy of Sciences. 657: 194–203. doi:10.1111/j.1749-6632.1992.tb22768.x. PMID 1637085.
  15. Joyce CD, Fiscus RR, Wang X, Dries DJ, Morris RC, Prinz RA (December 1990). "Calcitonin gene-related peptide levels are elevated in patients with sepsis". Surgery. 108 (6): 1097–101. PMID 2247835.
  16. Edvinsson L, Goadsby PJ (October 1994). "Neuropeptides in migraine and cluster headache". Cephalalgia. 14 (5): 320–7. doi:10.1046/j.1468-2982.1994.1405320.x. PMID 7828188.
  17. Ferrari MD, Saxena PR (June 1993). "On serotonin and migraine: a clinical and pharmacological review". Cephalalgia. 13 (3): 151–65. doi:10.1046/j.1468-2982.1993.1303151.x. PMID 8395342.
  18. Goadsby PJ, Edvinsson L (June 1994). "Human in vivo evidence for trigeminovascular activation in cluster headache. Neuropeptide changes and effects of acute attacks therapies". Brain. 117 ( Pt 3) (3): 427–34. doi:10.1093/brain/117.3.427. PMID 7518321.
  19. Russell FA, King R, Smillie SJ, Kodji X, Brain SD (October 2014). "Calcitonin gene-related peptide: physiology and pathophysiology". Physiological Reviews. 94 (4): 1099–142. doi:10.1152/physrev.00034.2013. PMC 4187032. PMID 25287861. Retrieved 2015-04-17.
  20. Pellesi L, Guerzoni S, Pini LA (November 2017). "Spotlight on Anti-CGRP Monoclonal Antibodies in Migraine: The Clinical Evidence to Date". Clinical Pharmacology in Drug Development. 6 (6): 534–547. doi:10.1002/cpdd.345. PMC 5697612. PMID 28409893.
  21. 21.0 21.1 21.2 Durham PL (June 2006). "Calcitonin gene-related peptide (CGRP) and migraine". Headache. 46 Suppl 1 (Suppl 1): S3–8. doi:10.1111/j.1526-4610.2006.00483.x. PMC 3134175. PMID 16927957.
  22. 22.0 22.1 Goadsby PJ, Edvinsson L, Ekman R (August 1990). "Vasoactive peptide release in the extracerebral circulation of humans during migraine headache". Annals of Neurology. 28 (2): 183–7. doi:10.1002/ana.410280213. PMID 1699472.
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  24. Lassen LH, Haderslev PA, Jacobsen VB, Iversen HK, Sperling B, Olesen J (February 2002). "CGRP may play a causative role in migraine". Cephalalgia. 22 (1): 54–61. doi:10.1046/j.1468-2982.2002.00310.x. PMID 11993614.

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