Alfa-1 Antitripsin Eksikliğinde Migren Nedenselliği

Yıl 2024, Cilt: 26 Sayı: 2, 179 - 182, 30.08.2024

Esra Demir Unal

https://doi.org/10.18678/dtfd.1447131

Öz

Alfa1-antitripsin (A1AT), çeşitli inflamatuar durumlarda anti-inflamatuar ve immünomodülatör etkilerle ilişkili antiproteaz aktivitesine sahip bir anti-inflamatuar aracıdır. A1AT eksikliği (A1ATE), akciğer hastalığı (amfizem ve bronşektazi), karaciğer hastalığı (kronik hepatit, siroz ve hepatoma) ve cilt hastalıkları (pannikülit) gibi çeşitli hiperinflamatuar hastalıklarla ilişkilendirilmiştir. Auralı migren, etyopatogenezinde kortikal yayılan depresyon ve glial hiperinflamasyonla ilişkili nöroimmünolojik aktivasyon ve nöroinflamasyonla ilişkili olan yaygın migren alt tiplerinden biri olup şimdiye kadar açıklanan ana mekanizmalar, proinflamatuar mediatörlerin hiperinflamasyonu, trigeminal sinir liflerinin duyarlılığı ve ağrıyla konjuge glial hücrelerin aktivasyonudur. Bu vaka raporunda, sistemik hiperinflamatuar süreçlerin santral yansımalarını gösteren etioradiopatogenetik mekanizmalar üzerinden auralı migren ve A1ATE'nin nedensel bir perspektifi sunulmuş ve periferik hiperinflamatuar durumların migren etiyolojisindeki önemi incelenmiştir.

Anahtar Kelimeler

Alfa-1 antitripsin eksikliği, kortikal yayılan depresyon, hepatoserebral yollar, migren, nöroimmün aktivasyon, nöroinflamasyon

Migraine Causality in Alpha-1 Antitrypsin Deficiency

Öz

Alpha1-antitrypsin (A1AT) is an anti-inflammatory mediator with antiprotease activity associated with anti-inflammatory and immunomodulatory effects in various inflammatory conditions. A1AT deficiency (A1ATD) has been associated with various hyperinflammatory diseases, such as lung disease (emphysema and bronchiectasis), liver disease (chronic hepatitis, cirrhosis, and hepatoma), and skin diseases (panniculitis). Migraine with aura is one of the common migraine subtypes associated with neuroimmunologic activation and neuroinflammation which is associated with cortical spreading depression and glial hyperinflammation in etioradiopathogenesis, and the main mechanisms explained so far are hyperinflammation of pro-inflammatory mediators, sensitivity of trigeminal nerve fibers and pain-conjugated glial cells activation. In this case report, a causative perspective of migraine with aura and A1ATD was presented through etioradiopathogenetics mechanisms that show the central reflections of systemic hyperinflammatory processes, and the importance of peripheral hyperinflammatory conditions in migraine etiology was examined.

Anahtar Kelimeler

Alpha-1 antitrypsin deficiency, cortical spreading depression, hepatocerebral pathways, migraine, neuroimmune activation, neuroinflammation

Kaynakça

• Saryal S. Alfa-1 antitripsin eksikliği ve replasman tedavisi. Akciğer Bülteni. 2020;8(1):8-16. Turkish.
• Cosio MG, Bazzan E, Rigobello C, Tinè M, Turato G, Baraldo S, et al. Alpha-1 antitrypsin deficiency: beyond the protease/antiprotease paradigm. Ann Am Thorac Soc. 2016;13(Suppl 4):S305-10.
• Albrecht DS, Mainero C, Ichijo E, Ward N, Granziera C, Zürcher NR, et al. Imaging of neuroinflammation in migraine with aura: A [11C]PBR28 PET/MRI study. Neurology. 2019;92(17):e2038-50.
• Wanner A. Alpha-1 antitrypsin as a therapeutic agent for conditions not associated with alpha-1 antitrypsin deficiency. In: Wanner A, Sandhaus R, editors. Alpha-1 Antitrypsin. Humana Press, Cham; 2016. p.141-55.
• O'Brien ME, Fee L, Browne N, Carroll TP, Meleady P, Henry M, et al. Activation of complement component 3 is associated with airways disease and pulmonary emphysema in alpha-1 antitrypsin deficiency. Thorax. 2020;75(4):321-30.
• Kokturk N, Khodayari N, Lascano J, Riley EL, Brantly ML. Lung Inflammation in alpha-1-antitrypsin deficient individuals with normal lung function. Respir Res. 2023;24(1):40.
• Lee J, Mohammad N, Lu Y, Kang K, Han K, Brantly M. Alu RNA induces NLRP3 expression through TLR7 activation in α-1-antitrypsin-deficient macrophages. JCI Insight. 2022;7(12):e158791.
• Hadjikhani N, Albrecht DS, Mainero C, Ichijo E, Ward N, Granziera C, et al. Extra-axial inflammatory signal in parameninges in migraine with visual aura. Ann Neurol. 2020;87(6):939-49.
• Summ O, Gregor N, Marziniak M, Gralow I, Husstedt IW, Evers S. Cluster headache and alpha 1-antitrypsin deficiency. Cephalalgia. 2010;30(1):113-7.
• Pellesi L, Guerzoni S, Baraldi C, Cainazzo MM, Pini LA, Bellei E. Identification of candidate proteomic markers in the serum of medication overuse headache patients: An exploratory study. Cephalalgia. 2020;40(10):1070-8.