Increased Role of E Prostanoid Receptor-3 in Prostacyclin
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Cox Inhibitors and Thromboregulation
CLINICAL IMPLICATIONS OF BASIC RESEARCH Clinical Implications shown the importance of eicosanoids in preserving of Basic Research the dynamic balance among thrombosis, hemostasis, and the fluidity of blood. Recently, Cheng et al.1 presented compelling evi- dence that cell–cell interactions, principally between platelets and endothelial cells, that are mediated by ei- COX INHIBITORS cosanoids have a role in thrombosis. Using genetical- AND THROMBOREGULATION ly engineered mice that either overexpressed or lacked essential components of the eicosanoid pathway — ROM a historical perspective, there is perhaps no namely, receptors for prostacyclin (a platelet inhibitor Fmore interesting therapeutic saga than that of as- and vasodilator) or thromboxane A2 (a platelet agonist pirin, which began as a folk remedy, distilled from wil- and vasoconstrictor) — they found that the response low bark, and became a lifesaving preventive treatment of the intima of carotid vessels to mechanical injury is for ischemic cardiovascular disease. Aspirin primarily exuberant and leads to obstruction in mice lacking the inhibits the cyclooxygenase (COX)-dependent synthe- prostacyclin receptor. However, this response is muted sis of eicosanoids, which are the end products of me- in mice lacking the thromboxane A2 receptor or both tabolism of essential fatty acids and include prosta- receptors. In mice lacking the prostacyclin receptor cyclin and thromboxane A2. Numerous studies have (a defect that mimics the effects of COX-2–selective Endothelial cell Resting platelet Thromboxane A2 Soluble Stimulation CD39 Arachidonic acid Stimulated platelet COX inhibitor ATP and ADP Prostacyclin Nitric oxide AMP Carbon monoxide CD39 Resting platelet Figure 1. Effect on Platelet Reactivity of the Eicosanoids Thromboxane A2 and Prostacyclin, the Biologic Gases Nitric Oxide and Carbon Monoxide, and the Ectonucleotidase CD39. -
Endogenous Biosynthesis of Prostacyclin and Thromboxane and Platelet Function During Chronic Administration of Aspirin in Man
Endogenous biosynthesis of prostacyclin and thromboxane and platelet function during chronic administration of aspirin in man. G A FitzGerald, … , J A Lawson, A R Brash J Clin Invest. 1983;71(3):676-688. https://doi.org/10.1172/JCI110814. Research Article To assess the pharmacologic effects of aspirin on endogenous prostacyclin and thromboxane biosynthesis, 2,3-dinor-6- keto PGF1 alpha (PGI-M) and 2,3-dinor-thromboxane B2 (Tx-M) were measured in urine by mass spectrometry during continuing administration of aspirin. To define the relationship of aspirin intake to endogenous prostacyclin biosynthesis, sequential urines were initially collected in individuals prior to, during, and subsequent to administration of aspirin. Despite inter- and intra-individual variations, PGI-M excretion was significantly reduced by aspirin. However, full mass spectral identification confirmed continuing prostacyclin biosynthesis during aspirin therapy. Recovery of prostacyclin biosynthesis was incomplete 5 d after drug administration was discontinued. To relate aspirin intake to indices of thromboxane biosynthesis and platelet function, volunteers received 20 mg aspirin daily followed by 2,600 mg aspirin daily, each dose for 7 d in sequential weeks. Increasing aspirin dosage inhibited Tx-M excretion from 70 to 98% of pretreatment control values; platelet TxB2 formation from 4.9 to 0.5% and further inhibited platelet function. An extended study was performed to relate aspirin intake to both thromboxane and prostacyclin generation over a wide range of doses. Aspirin, in the range of 20 to 325 mg/d, resulted in a dose-dependent decline in both Tx-M and PGI-M excretion. At doses of 325-2,600 mg/d Tx-M excretion ranged from 5 to 3% of control values while PGI-M remained at 37-23% of control. -
Challenging the FDA Black Box Warning for High Aspirin Dose with Ticagrelor in Patients with Diabetes James J
PERSPECTIVES IN DIABETES Challenging the FDA Black Box Warning for High Aspirin Dose With Ticagrelor in Patients With Diabetes James J. DiNicolantonio and Victor L. Serebruany – Ticagrelor, a novel reversible antiplatelet agent, has a Food and ASA 300 325 mg (53.6%) in the U.S. compared with the Drug Administration (FDA) black box warning to avoid mainte- rest of the world (1.7%) was the only factor to explain nance doses of aspirin (ASA) .100 mg/daily. This restriction is (out of 37 variables explored) the regional interaction based on the hypothesis that ASA doses .100 mg somehow de- that ticagrelor was less effective and potentially more creased ticagrelor’s benefit in the Platelet Inhibition and Patient harmful than clopidogrel (2). However, this interaction Outcomes (PLATO) U.S. cohort. However, these data are highly was not significant, is highly postrandomized, comes postrandomized, come from a very small subgroup in PLATO from a very small subgroup of PLATO, and makes no (57% of patients in the U.S. site), and make no biological sense. biological sense (3). Moreover, the ticagrelor-ASA interaction was not significant by any multivariate Cox regression analyses. The Complete Re- sponse Review for ticagrelor indicates that for U.S. PLATO patients, an ASA dose .300 mg was not a significant interaction TICAGRELOR-ASA HYPOTHESIS for vascular outcomes. In the ticagrelor-ASA .300 mg cohort, all- The claimed ticagrelor-ASA interaction states that ticagrelor cause and vascular mortality were not significantly increased fi – P plus low-dose ASA is bene cial, whereas increasing doses (hazard ratio [HR] 1.27 [95% CI 0.84 1.93], = 0.262 and 1.39 of ASA in combination with ticagrelor produces adverse [0.87–2.2], P = 0.170), respectively. -
GTH 2021 State of the Art—Cardiac Surgery: the Perioperative Management of Heparin-Induced Thrombocytopenia in Cardiac Surgery
Review Article 59 GTH 2021 State of the Art—Cardiac Surgery: The Perioperative Management of Heparin-Induced Thrombocytopenia in Cardiac Surgery Laura Ranta1 Emmanuelle Scala1 1 Department of Anesthesiology, Cardiothoracic and Vascular Address for correspondence Emmanuelle Scala, MD, Centre Anesthesia, Lausanne University Hospital (CHUV), Lausanne, Hospitalier Universitaire Vaudois, Rue du Bugnon 46, BH 05/300, 1011 Switzerland Lausanne, Suisse, Switzerland (e-mail: [email protected]). Hämostaseologie 2021;41:59–62. Abstract Heparin-induced thrombocytopenia (HIT) is a severe, immune-mediated, adverse drug Keywords reaction that paradoxically induces a prothrombotic state. Particularly in the setting of ► Heparin-induced cardiac surgery, where full anticoagulation is required during cardiopulmonary bypass, thrombocytopenia the management of HIT can be highly challenging, and requires a multidisciplinary ► cardiac surgery approach. In this short review, the different perioperative strategies to run cardiopul- ► state of the art monary bypass will be summarized. Introduction genicity of the antibodies and is diagnostic for HIT. The administration of heparin to a patient with circulating Heparin-induced thrombocytopenia (HIT) is a severe, im- pathogenic HITabs puts the patient at immediate risk of mune-mediated, adverse drug reaction that paradoxically severe thrombotic complications. induces a prothrombotic state.1,2 Particularly in the setting The time course of HIT can be divided into four distinct of cardiac surgery, where full anticoagulation is required phases.6 Acute HIT is characterized by thrombocytopenia during cardiopulmonary bypass (CPB), the management of and/or thrombosis, the presence of HITabs, and confirma- HIT can be highly challenging, and requires a multidisciplin- tion of their platelet activating capacity by a functional ary approach. -
Inverse Agonism of SQ 29,548 and Ramatroban on Thromboxane A2 Receptor
Inverse Agonism of SQ 29,548 and Ramatroban on Thromboxane A2 Receptor Raja Chakraborty1,3, Rajinder P. Bhullar1, Shyamala Dakshinamurti2,3, John Hwa4, Prashen Chelikani1,2,3* 1 Department of Oral Biology, University of Manitoba, Winnipeg, Manitoba, Canada, 2 Departments of Pediatrics, Physiology, University of Manitoba, Winnipeg, Manitoba, Canada, 3 Biology of Breathing Group- Manitoba Institute of Child Health, Winnipeg, Manitoba, Canada, 4 Department of Internal Medicine (Cardiology), Cardiovascular Research Center, Yale University School of Medicine, New Haven, Connecticut, United States of America Abstract G protein-coupled receptors (GPCRs) show some level of basal activity even in the absence of an agonist, a phenomenon referred to as constitutive activity. Such constitutive activity in GPCRs is known to have important pathophysiological roles in human disease. The thromboxane A2 receptor (TP) is a GPCR that promotes thrombosis in response to binding of the prostanoid, thromboxane A2. TP dysfunction is widely implicated in pathophysiological conditions such as bleeding disorders, hypertension and cardiovascular disease. Recently, we reported the characterization of a few constitutively active mutants (CAMs) in TP, including a genetic variant A160T. Using these CAMs as reporters, we now test the inverse agonist properties of known antagonists of TP, SQ 29,548, Ramatroban, L-670596 and Diclofenac, in HEK293T cells. Interestingly, SQ 29,548 reduced the basal activity of both, WT-TP and the CAMs while Ramatroban was able to reduce the basal activity of only the CAMs. Diclofenac and L-670596 showed no statistically significant reduction in basal activity of WT-TP or CAMs. To investigate the role of these compounds on human platelet function, we tested their effects on human megakaryocyte based system for platelet activation. -
Effects of Selexipag and Its Active Metabolite in Contrasting The
Cutolo et al. Arthritis Research & Therapy (2018) 20:77 https://doi.org/10.1186/s13075-018-1577-0 RESEARCH ARTICLE Open Access Effects of selexipag and its active metabolite in contrasting the profibrotic myofibroblast activity in cultured scleroderma skin fibroblasts Maurizio Cutolo1*, Barbara Ruaro1, Paola Montagna1, Renata Brizzolara1, Emanuela Stratta2, Amelia Chiara Trombetta1, Stefano Scabini2, Pier Paolo Tavilla3, Aurora Parodi3, Claudio Corallo4, Nicola Giordano4, Sabrina Paolino1, Carmen Pizzorni1, Alberto Sulli1, Vanessa Smith5 and Stefano Soldano1 Abstract Background: Myofibroblasts contribute to fibrosis through the overproduction of extracellular matrix (ECM) proteins, primarily type I collagen (COL-1) and fibronectin (FN), a process which is mediated in systemic sclerosis (SSc) by the activation of fibrogenic intracellular signaling transduction molecules, including extracellular signal-regulated kinases 1 and 2 (Erk1/2) and protein kinase B (Akt). Selexipag is a prostacyclin receptor agonist synthesized for the treatment of pulmonary arterial hypertension. The study investigated the possibility for selexipag and its active metabolite (ACT-333679) to downregulate the profibrotic activity in primary cultures of SSc fibroblasts/myofibroblasts and the fibrogenic signaling molecules involved. Methods: Fibroblasts from skin biopsies obtained with Ethics Committee (EC) approval from patients with SSc, after giving signed informed consent, were cultured until the 3rd culture passage and then either maintained in normal growth medium (untreated cells) or independently treated with different concentrations of selexipag (from 30 μMto 0.3 μM) or ACT-333679 (from 10 μMto0.1μM) for 48 h. Protein and gene expressions of α-smooth muscle actin (α-SMA), fibroblast specific protein-1 (S100A4), COL-1, and FN were investigated by western blotting and quantitative real-time PCR. -
Cyclooxygenase Pathway
Cyclooxygenase Pathway Diverse physical, chemical, Phospholipase A Glucocorticoids inflammatory, and 2 mitogenic stimuli NSAIDs NSAIDs Arachidonic Acid Prostaglandin G2 CYCLOOXYGENASE Prostaglandin G2 Prostaglandin H Prostaglandin H Synthase-1 Synthase-2 (COX 1) (COX 2) Prostaglandin H2 PEROXIDASE Prostaglandin H2 Tissue Specific Isomerases Prostacyclin Thromboxane A2 Prostaglandin D2 Prostaglandin E2 Prostaglandin F2α IP TPα, TPβ DP1, DP2 EP1, EP2, EP3, EP4 FPα, FPβ Endothelium, Kidney, Platelets, Vascular Mast Cells, Brain, Brain, Kidney, Vascular Uterus, Airways, Vascular Platelets, Brain Smooth Muscle Cells, Airways, Lymphocytes, Smooth Muscle Cells, Smooth Muscle Cells, Macrophages, Kidney Eosinophils Platelets Eyes Prostacyclin Item No. Product Features Prostacyclin (Prostaglandin I2; PGI2) is formed from arachidonic acid primarily in the vascular endothelium and renal cortex by sequential 515211 6-keto • Sample Types: Culture Medium | Plasma Prostaglandin • Measure 6-keto PGF levels down to 6 pg/ml activities of COX and prostacyclin synthase. PGI2 is non-enzymatically 1α F ELISA Kit • Incubation : 18 hours | Development: 90-120 minutes | hydrated to 6-keto PGF1α (t½ = 2-3 minutes), and then quickly converted 1α Read: Colorimetric at 405-420 nm to the major metabolite, 2,3-dinor-6-keto PGF1α (t½= 30 minutes). Prostacyclin was once thought to be a circulating hormone that regulated • Assay 24 samples in triplicate or 36 samples in duplicate platelet-vasculature interactions, but the rate of secretion into circulation • NOTE: A portion of urinary 6-keto PGF1α is of renal origin coupled with the short half-life indicate that prostacyclin functions • NOTE : It has been found that normal plasma levels of 6-keto PGF may be low locally. -
Vasoactive Responses of U46619, PGF2 , Latanoprost, and Travoprost
Vasoactive Responses of U46619, PGF2␣, Latanoprost, and Travoprost in Isolated Porcine Ciliary Arteries Ineta Vysniauskiene, Reto Allemann, Josef Flammer, and Ivan O. Haefliger PURPOSE. To compare the vasoactive properties of the prosta- these responses can be modulated by SQ 29548 (TP-receptor noids U46619 (thromboxane A2 analogue), prostaglandin F2␣ antagonist) or AL-8810 (FP-receptor antagonist). (PGF2␣), latanoprost free acid, and travoprost free acid in isolated porcine ciliary arteries. METHODS. In a myograph system (isometric force measure- MATERIAL AND METHODS ment), quiescent vessels were exposed (cumulatively) to U46619, PGF , latanoprost, or travoprost (0.1 nM–0.1 mM). 2␣ Vessels Preparation Experiments were also conducted in the presence of SQ 29548 (TP-receptor antagonist; 3–10 M) or AL-8810 (FP-receptor Porcine eyes were obtained from an abattoir immediately after death. antagonist; 3–30 M). Contractions were expressed as the In cold modified Krebs-Ringer solution (NaCl 118 mM, KCl 4.7 mM, percentage of 100 mM potassium chloride-induced contrac- CaCl2 2.5 mM, K2PO4 1.2 mM, MgSO4 1.2 mM, NaHCO3 25 mM, tions. glucose 11.1 mM, and EDTA 0.026 mM), ciliary arteries were dissected 5 RESULTS. In quiescent vessels, contractions (concentration–re- and cut into 2-mm segments. In an organ chamber, two 45- m Ϯ tungsten wires were passed through the vessel’s lumen and attached to sponse curves) induced by (0.1 mM) PGF2␣ (87.9% 3.5%), U46619 (66.7% Ϯ 4.1%), and latanoprost (62.9% Ϯ 3.6%) were a force transducer for isometric force measurements (Myo-Interface; JP more pronounced (P Յ 0.001) than those induced by tra- Trading, Aarhus, Denmark). -
Effect of Prostanoids on Human Platelet Function: an Overview
International Journal of Molecular Sciences Review Effect of Prostanoids on Human Platelet Function: An Overview Steffen Braune, Jan-Heiner Küpper and Friedrich Jung * Institute of Biotechnology, Molecular Cell Biology, Brandenburg University of Technology, 01968 Senftenberg, Germany; steff[email protected] (S.B.); [email protected] (J.-H.K.) * Correspondence: [email protected] Received: 23 October 2020; Accepted: 23 November 2020; Published: 27 November 2020 Abstract: Prostanoids are bioactive lipid mediators and take part in many physiological and pathophysiological processes in practically every organ, tissue and cell, including the vascular, renal, gastrointestinal and reproductive systems. In this review, we focus on their influence on platelets, which are key elements in thrombosis and hemostasis. The function of platelets is influenced by mediators in the blood and the vascular wall. Activated platelets aggregate and release bioactive substances, thereby activating further neighbored platelets, which finally can lead to the formation of thrombi. Prostanoids regulate the function of blood platelets by both activating or inhibiting and so are involved in hemostasis. Each prostanoid has a unique activity profile and, thus, a specific profile of action. This article reviews the effects of the following prostanoids: prostaglandin-D2 (PGD2), prostaglandin-E1, -E2 and E3 (PGE1, PGE2, PGE3), prostaglandin F2α (PGF2α), prostacyclin (PGI2) and thromboxane-A2 (TXA2) on platelet activation and aggregation via their respective receptors. Keywords: prostacyclin; thromboxane; prostaglandin; platelets 1. Introduction Hemostasis is a complex process that requires the interplay of multiple physiological pathways. Cellular and molecular mechanisms interact to stop bleedings of injured blood vessels or to seal denuded sub-endothelium with localized clot formation (Figure1). -
Activation of the Murine EP3 Receptor for PGE2 Inhibits Camp Production and Promotes Platelet Aggregation
Activation of the murine EP3 receptor for PGE2 inhibits cAMP production and promotes platelet aggregation Jean-Etienne Fabre, … , Thomas M. Coffman, Beverly H. Koller J Clin Invest. 2001;107(5):603-610. https://doi.org/10.1172/JCI10881. Article The importance of arachidonic acid metabolites (termed eicosanoids), particularly those derived from the COX-1 and COX-2 pathways (termed prostanoids), in platelet homeostasis has long been recognized. Thromboxane is a potent agonist, whereas prostacyclin is an inhibitor of platelet aggregation. In contrast, the effect of prostaglandin E2 (PGE2) on platelet aggregation varies significantly depending on its concentration. Low concentrations of PGE2 enhance platelet aggregation, whereas high PGE2 levels inhibit aggregation. The mechanism for this dual action of PGE2 is not clear. This study shows that among the four PGE2 receptors (EP1–EP4), activation of EP3 is sufficient to mediate the proaggregatory actions of low PGE2 concentration. In contrast, the prostacyclin receptor (IP) mediates the inhibitory effect of higher PGE2 concentrations. Furthermore, the relative activation of these two receptors, EP3 and IP, regulates the intracellular level of cAMP and in this way conditions the response of the platelet to aggregating agents. Consistent with these findings, loss of the EP3 receptor in a model of venous inflammation protects against formation of intravascular clots. Our results suggest that local production of PGE2 during an inflammatory process can modulate ensuing platelet responses. Find the latest version: https://jci.me/10881/pdf Activation of the murine EP3 receptor for PGE2 inhibits cAMP production and promotes platelet aggregation Jean-Etienne Fabre,1 MyTrang Nguyen,1 Krairek Athirakul,2 Kenneth Coggins,1 John D. -
Nanosuspensions of Selexipag: Formulation, Characterization, and in Vitro Evaluation Rusul M
Iraqi J Pharm Sci, Vol.30(1) 2021 Selexipag nanosuspension DOI : https://doi.org/10.31351/vol30iss1pp144-153 Nanosuspensions of Selexipag: Formulation, Characterization, and in vitro Evaluation Rusul M. Alwan*,1 and Nawal A. Rajab** * Ministry of Health and Environment, Najaf Health Department, Najaf, Iraq. **Department of Pharmaceutics, College of Pharmacy, University of Baghdad, Baghdad, Iraq. Abstract Selexipag(SLP) is an orally selective long-acting prostacyclin receptor agonist indicated for pulmonary arterial hypertension treatment. It is practically insoluble in water (class II, according to BCS). This work aims to prepare and optimize Selexipag nanosuspensions (SLPNS) to enhance the saturation solubility and in vitro dissolution rate. The solvent antisolvent precipitation method was used for the production of NS, and the effect of formulation parameters (stabilizer type, drug: stabilizer ratio, and use of co-stabilizer) and process parameter (stirring speed) on the particle size (P.S) and polydispersity index (PDI) were studied. The result revealed that the P.S of all prepared SLPNS formulation was in the nanometer range, except for the formulas that stabilized by Poloxamer. The optimal SLPNS (F15), which is stabilized by Soluplus® (SLP: stabilizer ratio 1:2) and prepared at a stirring speed of 1000 rpm, showed the smallest P.S and appropriate PDI, which are 47 nm and 0.073. The formula F5 exhibits 136 folds, an increase in the saturation solubility, and an enhancement in the dissolution rate in phosphate buffer pH 6.8 (100% drug release during 60 min) compared to the pure drug. This result indicates that SLPNS is an efficient way for improving the saturation solubility and the dissolution rate of SLP. -
Nonsteroidal Antiinflammatory Drugs Inhibiting Prostanoid Efflux: As Easy As ABC?
Nonsteroidal antiinflammatory drugs inhibiting prostanoid efflux: As easy as ABC? Timothy D. Warner*† and Jane A. Mitchell‡ *The William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, United Kingdom; and ‡National Heart and Lung Institute, Imperial College School of Medicine, Dovehouse Street, London SW3 6LY, United Kingdom onsteroidal antiinflammatory may explain its antinociceptive proper- resistance proteins (MRP) form a sub- drugs (NSAIDs) and prosta- ties (7). Others have found therapeutic family within the ABC transporters. noids continue to be fascinat- effects of NSAID metabolites that are MRP1 is a high-affinity leukotriene C4 N ing research targets. Humans inactive on COX; sulindac sulfone is a transporter, and mice that harbor dele- have been using NSAIDs in one form or clear example. The NSAID sulindac is tions of this gene have an altered re- another, from folk remedies through to an inactive drug metabolized to a phar- sponse to inflammatory stimuli but are the products of modern pharmaceutical macologically active sulfide derivative, otherwise healthy and fertile. MRP2 is research, for thousands of years. How- which potently inhibits COX. Sulindac is the major transporter responsible for ever, we still have not characterized all also metabolized to a sulfone derivative the secretion of bilirubin glucuronides of the systems through which these that is inactive against COX. However, into bile (11). MRP1 and -4 may also be drugs produce their beneficial and like sulindac sulfide, sulindac sulfone involved in the transport of dehydroepi- harmful effects (1, 2). We are certain, both promotes cellular apoptosis and androsterone 3-sulfate (the most abun- from seminal work carried out in the dant circulating steroid in humans), and 1960s and early 1970s, that NSAIDs MRP4 transports conjugated steroids have the common property of inhibiting Some NSAIDs and bile acids (12).