Prostacyclin

Prostacyclin

Clinical data
AHFS/Drugs.com	Monograph
ATC code	B01AC09 (WHO)
Identifiers
IUPAC name (Z)-5-[(4R,5R)-5-Hydroxy-4-((S,E)-3-hydroxyoct-1-enyl)hexahydro-2H-cyclopenta[b]furan-2-ylidene]pentanoic acid
CAS Number	35121-78-9 Y
PubChem (CID)	5282411
IUPHAR/BPS	1915
DrugBank	DB01240 N
ChemSpider	4445566 N
ChEMBL	CHEMBL962 N
Chemical and physical data
Formula	C20H32O5
Molar mass	352.465 g/mol
3D model (Jmol)	Interactive image
SMILES OC(=O)CCC\C=C1\C[C@@H]2[C@@H](/C=C/[C@@H](O)CCCCC)[C@H](O)C[C@@H]2O1
InChI InChI=1S/C20H32O5/c1-2-3-4-7-14(21)10-11-16-17-12-15(8-5-6-9-20(23)24)25-19(17)13-18(16)22/h8,10-11,14,16-19,21-22H,2-7,9,12-13H2,1H3,(H,23,24)/b11-10+,15-8-/t14-,16+,17+,18+,19-/m0/s1 N Key:KAQKFAOMNZTLHT-OZUDYXHBSA-N N
NY (what is this?)  (verify)

Prostacyclin (also called prostaglandin I2 or PGI₂) is a prostaglandin member of the eicosanoid family of lipid molecules. It inhibits platelet activation and is also an effective vasodilator.

When used as a drug, it is also known as epoprostenol.^[1] The terms are sometimes used interchangeably.^[2]

History

During the 1960s, a U.K. research team, headed by Professor John Vane, began to explore the role of prostaglandins in anaphylaxis and respiratory diseases. Working with a team from the Royal College of Surgeons, Sir John discovered that aspirin and other oral anti-inflammatory drugs work by inhibiting the synthesis of prostaglandins. This critical finding opened the door to a broader understanding of the role of prostaglandins in the body.

Sir John and a team from the Wellcome Foundation, had identified a lipid mediator they called “PG-X,” which inhibits platelet aggregation. PG-X, which later would become known as prostacyclin, is 30 times more potent than any other then-known anti-aggregatory agent.

By 1976, John Vane and fellow researchers Salvador Moncada, Ryszard Gryglewski and Stuart Bunting published the first paper on prostacyclin, in the scientific journal Nature.^[3] The collaboration produced a synthesized molecule, which was given the name epoprostenol. But, as with native prostacyclin, the structure of the epoprostenol molecule proved to be unstable in solution, prone to rapid degradation. This presented a challenge for both in vitro experiments and clinical applications.

To overcome this challenge, the research team that discovered prostacyclin was determined to continue the research in an attempt to build upon the success they had seen with the prototype molecule. The research team synthesized nearly 1,000 analogues.

Bio-synthesis

Eicosanoid synthesis. (Prostacyclin near bottom center.)

Prostacyclin is produced in endothelial cells, which line the walls of arteries and veins,^[4] from prostaglandin H₂ (PGH₂) by the action of the enzyme prostacyclin synthase. Although prostacyclin is considered an independent mediator, it is called PGI₂ (prostaglandin I₂) in eicosanoid nomenclature, and is a member of the prostanoids (together with the prostaglandins and thromboxane).

The series-3 prostaglandin PGH₃ also follows the prostacyclin synthase pathway, yielding another prostacyclin, PGI₃.^[5] The unqualified term 'prostacyclin' usually refers to PGI₂. PGI₂ is derived from the ω-6 arachidonic acid. PGI₃ is derived from the ω-3 EPA.

Function

Prostacyclin (PGI₂) chiefly prevents formation of the platelet plug involved in primary hemostasis (a part of blood clot formation). It does this by inhibiting platelet activation.^[6] It is also an effective vasodilator. Prostacyclin's interactions in contrast to thromboxane (TXA₂), another eicosanoid, strongly suggest a mechanism of cardiovascular homeostasis between the two hormones in relation to vascular damage.

Degradation

Prostacyclin, which has a half-life of 42 seconds,^[7] is broken down into 6-keto-PGF₁, which is a much weaker vasodilator.

Mode of action

Prostacyclin effect		Mechanism	Cellular response
Classical functions	Vessel tone	↑cAMP, ↓ET-1 ↓Ca2+, ↑K+	↓SMC proliferation ↑Vasodilation
	Antiproliferative	↑cAMP ↑PPARgamma	↓Fibroblast growth ↑Apoptosis
	Antithrombotic	↓Thromboxane-A2 ↓PDGF	↓Platelet aggregation ↓Platelet adherence to vessel wall
Novel functions	Antiinflammatory	↓IL-1, IL-6 ↑IL-10	↓Proinflammatory cytokines ↑Antiinflammatory cytokines
	Antimitogenic	↓VEGF ↓TGF-β	↓Angiogenesis ↑ECM remodeling

Prostacyclin (PGI₂) is released by healthy endothelial cells and performs its function through a paracrine signaling cascade that involves G protein-coupled receptors on nearby platelets and endothelial cells. The platelet Gs protein-coupled receptor (prostacyclin receptor) is activated when it binds to PGI₂. This activation, in turn, signals adenylyl cyclase to produce cAMP. cAMP goes on to inhibit any undue platelet activation (in order to promote circulation) and also counteracts any increase in cytosolic calcium levels that would result from thromboxane A2 (TXA₂) binding (leading to platelet activation and subsequent coagulation). PGI₂ also binds to endothelial prostacyclin receptors and in the same manner raise cAMP levels in the cytosol. This cAMP then goes on to activate protein kinase A (PKA). PKA then continues the cascade by promoting the phosphorylation of the myosin light chain kinase, which inhibits it and leads to smooth muscle relaxation and vasodilation. It can be noted that PGI₂ and TXA₂ work as physiological antagonists.

Members^[8]

Pharmacology

Ball-and-stick model of prostacyclin

Synthetic prostacyclin analogues (iloprost, cisaprost) are used intravenously, subcutaneously or by inhalation:

• as a vasodilator in severe Raynaud's phenomenon or ischemia of a limb;
• in pulmonary hypertension.
• in primary pulmonary hypertension (PPH)

The drug is clear with a pH of 10.^[9] Its production is inhibited indirectly by NSAIDs, which inhibit the cyclooxygenase enzymes COX1 and COX2. These convert arachidonic acid to prostaglandin H2 (PGH₂), the immediate precursor of prostacyclin. Since thromboxane (an eicosanoid stimulator of platelet aggregation) is also downstream of COX enzymes, one might think that the effect of NSAIDs would act to balance. However, prostacyclin concentrations recover much faster than thromboxane levels, so aspirin administration initially has little to no effect but eventually prevents platelet aggregation (the effect of prostaglandins predominates as they are regenerated). This is explained by understanding the cells that produce each molecule, TXA₂ and PGI₂. Since PGI₂ is primarily produced in a nucleated endothelial cell, the COX inhibition by NSAID can be overcome with time by increased COX gene activation and subsequent production of more COX enzymes to catalyze the formation of PGI₂. In contrast, TXA₂ is released primarily by anucleated platelets, which are unable to respond to NSAID COX inhibition with additional transcription of the COX gene because they lack DNA material necessary to perform such a task. This allows NSAIDs to result in PGI₂ dominance that promotes circulation and retards thrombosis.

In patients with pulmonary hypertension, inhaled epoprostenol reduces pulmonary pressure, and improves right ventricular stroke work in patients undergoing cardiac surgery. A dose of 60 µg is hemodynamically safe, and its effect is completely reversed after 25 minutes. No evidence of platelet dysfunction or an increase in surgical bleeding after administration of inhaled epoprostenol has been found.^[10] The drug has been known to cause flushing, headaches and hypotension.^[11]

Synthesis

Prostacyclin can be synthesized from the methyl ester of prostaglandin F_2α.^[12] After its synthesis, the drug is reconstituted in saline and glycerin.^[13]

See also

• Essential fatty acid

References