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Evaluation Of Csf Neuropeptides And Peptidase Activities In Primary Headaches

Various neuropeptides seem to paticipate in the pain transmission mechanism, among which, substance P (SP) is the major candidate as transmitter of a certain sub-population of primary sensory neurons (1). Somatostatin (SST) is also contained within small diaixeter sensory fibres, although its possible role is less clear. SST is capable of inhibiting SP release and effects at both central and peripheral endings of sensory neurons ( 2 ) . (Met5 1 -enkephalin (ME is unevenly distributed in the brain, and that contained in some interneurons of the spinal cord and medulla oblongata seems to inhibit the activity of sensory afferents (3). Until now it has not been clarified how the peptide signal is turned off at the synaptic level. Since no re-uptake mechanism has been described, diffusion and degradation of peptide transmitters are considered the main form of inactivation. Enkephalinase has shown to inactivate enkephalins with high affinity, and its distribution parallels that of these opioid peptides (4). SP and ME are cleaved with high affinity also by the converting enzyme (ACE) which is largely distributed in various regions of the brain (5). In this study we have analyzed the immunoreactivities for SP (SP-LI), ME (ME-LI) and SST (SST-LI) and the activities of enkephalinase and ACE in the cerebrospinal fluid (CSF) in various pathological conditions among which primary headaches were included. MATERIALS AND METHODS Patients who were included in the study are summarized as follows: 7 cluster headache (CHI patients; 5 classic and 2 common migraine (MI sufferers; 6 chronic migraine (CM) patients; 9 subjects with non painful neurologicaldiseases; 10 patients with tumors of the genitourinary tract with a painful symptomatology (T(P)) and 11 2atients with tumors of the genitourinary tract without a recent hystory of pain (TI. The age range was 31-65 years. CSF specimens were drawn by lumbar