Increased calcitonin gene-related peptide in neuroma and invading macrophages is involved in the up-regulation of interleukin-6 and thermal hyperalgesia in a rat model of mononeuropathy

The pain related peptide, calcitonin gene-related peptide (CGRP), plays an important role in inflammatory pain and immune responses. However, its role in neuropathic pain is not established. Following nerve injury, CGRP and pro-inflammatory interleukin-6 (IL-6) are increased in injured nerves. The aim of this study was to determine if CGRP in injured nerves is involved in the up-regulation of IL-6 and in the maintenance of neuropathic pain. Perineural injection of a neutralizing IL-6 antiserum or CGRP receptor antagonists (CGRP8-37 and BIBN4096BS) effectively attenuated thermal hyperalgesia 4 weeks after partial sciatic nerve ligation. Perineural CGRP antagonists also dramatically reduced IL-6 level in injured nerves. CGRP release from injured sites was dramatically increased and CGRP immunoreactivity was localized in both neuroma and invading macrophages. CGRP receptor markers (CRLR and RAMP1) were expressed in invading macrophages. Both CGRP antagonists significantly reduced IL-6 release from injured nerve explants. In cell cultures derived from injured nerves, CGRP concentration-dependently increased IL-6 release, an effect also blocked by CGRP antagonists. Taken together, these data show that increased levels of CGRP in injured neuroma and invading macrophages are involved in the up-regulation of IL-6 in macrophages as well as in the maintenance of neuropathic pain.