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Hariri E, Kakouros N, Bunsick DA, Russell SD, Mudd JO, Laws K, Lake MW, Rade JJ. Non-platelet thromboxane generation is associated with impaired cardiovascular performance and mortality in heart failure. Am J Physiol Heart Circ Physiol 2022; 323:H248-H255. [PMID: 35714178 DOI: 10.1152/ajpheart.00212.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Non-platelet thromboxane generation, stimulated largely by oxidative stress, is a novel mortality risk factor in individuals with coronary artery disease. Though inversely associated with left ventricular ejection fraction (LVEF), a potential role in the pathobiology of heart failure (HF) remains poorly defined. METHODS Non-platelet thromboxane generation and oxidative stress were assessed by measuring urine thromboxane B2 metabolites (TXB2-M) and 8-isoPGF2α by ELISA in 105 subjects taking aspirin undergoing right heart catheterization for evaluation of HF, valve disease or after transplantation. Multivariable logistic regression and survival analyses were used to define associations of TXB2-M to invasive measures of cardiovascular performance and 4-year clinical outcome. RESULTS TXB2-M was elevated (>1500 pg/mg creatinine) in 46% of subjects and correlated with HF severity by NYHA functional class and brain natriuretic peptide level, modestly with LVEF, but not with HF etiology. There was no association of oxidative stress to HF type or etiology but a trend with NYHA functional class. Multiple invasive hemodynamic parameters independently associated with TXB2-M after adjustment for oxidative stress, age, sex and race with pulmonary effective arterial elastance (Ea (pulmonary)), reflective of right ventricular afterload, being the most robust on hierarchical analysis. Similar to Ea (pulmonary), elevated urinary TXB2-M associated with increased risk of death (adjusted HR 2.15, P=0.037) and combination of death, transplant, or mechanical support initiation (adjusted HR 2.0, P=0.042). CONCLUSIONS Non-platelet TXA2 thromboxane generation independently associated with HF severity reflected by invasive measures of cardiovascular performance, particularly right ventricular afterload, and independently predicted long-term mortal.
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Affiliation(s)
- Essa Hariri
- University of Massachusetts Medical School, Worcester, MA, United States.,Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Nikolaos Kakouros
- University of Massachusetts Medical School, Worcester, MA, United States
| | - David A Bunsick
- University of Massachusetts Medical School, Worcester, MA, United States
| | | | - James O Mudd
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Katherine Laws
- University of Massachusetts Medical School, Worcester, MA, United States
| | | | - Jeffrey J Rade
- University of Massachusetts Medical School, Worcester, MA, United States.,Cleveland Clinic Foundation, Cleveland, OH, United States
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Rade JJ, Barton BA, Vasan RS, Kronsberg SS, Xanthakis V, Keaney JF, Hamburg NM, Kakouros N, Kickler TA. Association of Thromboxane Generation With Survival in Aspirin Users and Nonusers. J Am Coll Cardiol 2022; 80:233-250. [PMID: 35660296 DOI: 10.1016/j.jacc.2022.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Persistent systemic thromboxane generation, predominantly from nonplatelet sources, in aspirin (ASA) users with cardiovascular disease (CVD) is a mortality risk factor. OBJECTIVES This study sought to determine the mortality risk associated with systemic thromboxane generation in an unselected population irrespective of ASA use. METHODS Stable thromboxane B2 metabolites (TXB2-M) were measured by enzyme-linked immunosorbent assay in banked urine from 3,044 participants (mean age 66 ± 9 years, 53.8% women) in the Framingham Heart Study. The association of TXB2-M to survival over a median observation period of 11.9 years (IQR: 10.6-12.7 years) was determined by multivariable modeling. RESULTS In 1,363 (44.8%) participants taking ASA at the index examination, median TXB2-M were lower than in ASA nonusers (1,147 pg/mg creatinine vs 4,179 pg/mg creatinine; P < 0.0001). TXB2-M were significantly associated with all-cause and cardiovascular mortality irrespective of ASA use (HR: 1.96 and 2.41, respectively; P < 0.0001 for both) for TXB2-M in the highest quartile based on ASA use compared with lower quartiles, and remained significant after adjustment for mortality risk factors for similarly aged individuals (HR: 1.49 and 1.82, respectively; P ≤ 0.005 for both). In 2,353 participants without CVD, TXB2-M were associated with cardiovascular mortality in ASA nonusers (adjusted HR: 3.04; 95% CI: 1.29-7.16) but not in ASA users, while ASA use was associated with all-cause mortality in those with low (adjusted HR: 1.46; 95% CI: 1.14-1.87) but not elevated TXB2-M. CONCLUSIONS Systemic thromboxane generation is an independent risk factor for all-cause and cardiovascular mortality irrespective of ASA use, and its measurement may be useful for therapy modification, particularly in those without CVD.
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Affiliation(s)
- Jeffrey J Rade
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA; Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
| | - Bruce A Barton
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | - Shari S Kronsberg
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | - John F Keaney
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA; Boston University School of Medicine, Boston, Massachusetts, USA
| | - Naomi M Hamburg
- Boston University School of Medicine, Boston, Massachusetts, USA
| | - Nikolaos Kakouros
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Wahab IA, Pratt NL, Ellett LK, Roughead EE. Sequence Symmetry Analysis as a Signal Detection Tool for Potential Heart Failure Adverse Events in an Administrative Claims Database. Drug Saf 2016; 39:347-54. [DOI: 10.1007/s40264-015-0391-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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KOEBERLE ANDREAS, WERZ OLIVER. Microsomal Prostaglandin E2 Synthase-1. ANTI-INFLAMMATORY DRUG DISCOVERY 2012. [DOI: 10.1039/9781849735346-00001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The prostanoids and leukotrienes (LTs) formed from arachidonic acid (AA) via the cyclooxygenase (COX)-1/2 and 5-lipoxygenase (5-LO) pathway, respectively, mediate inflammatory responses, chronic tissue remodelling, cancer, asthma and autoimmune disorders, but also possess homeostatic functions in the gastrointestinal tract, uterus, brain, kidney, vasculature and host defence. Based on the manifold functions of these eicosanoids, the clinical use of non-steroidal anti-inflammatory drugs (NSAIDs), a class of drugs that block formation of all prostanoids, is hampered by severe side-effects including gastrointestinal injury, renal irritations and cardiovascular risks. Therefore, anti-inflammatory agents interfering with eicosanoid biosynthesis require a well-balanced pharmacological profile to minimize these on-target side-effects. Current anti-inflammatory research aims at identifying compounds that can suppress the massive formation of pro-inflammatory prostaglandin (PG)E2 without affecting homeostatic PGE2 and PGI2 synthesis. The inducible microsomal prostaglandin E2 synthase-1 (mPGES-1) is one promising target enzyme. We will give an overview about the structure, regulation and function of mPGES-1 and then present novel inhibitors of mPGES-1 that may possess a promising pharmacological profile.
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Affiliation(s)
- ANDREAS KOEBERLE
- Chair of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy University Jena Philosophenweg 14, D-07743 Jena Germany
| | - OLIVER WERZ
- Chair of Pharmaceutical/Medicinal Chemistry, Institute of Pharmacy University Jena Philosophenweg 14, D-07743 Jena Germany
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Nodari S, Triggiani M, Manerba A, Milesi G, Dei Cas L. Effects of supplementation with polyunsaturated fatty acids in patients with heart failure. Intern Emerg Med 2011; 6 Suppl 1:37-44. [PMID: 22009611 DOI: 10.1007/s11739-011-0671-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Despite the clinical and prognostic improvement obtained with the current medical treatment, heart failure (HF) continues to have high morbidity and mortality and its prevalence is increasing in most regions of the world. Thus, there is a need for novel adjunctive therapies that act independently of current neurohormonally and haemodynamically oriented drugs. Nutritional approaches are particularly attractive because they could work additively with established therapies without negative hemodynamic effects. There is growing evidence that omega-3 polyunsaturated fatty acids (n-3 PUFAs) supplementation positively impacts established pathophysiological mechanisms in HF and thus has a potential role for preventing and treating HF. The results of the GISSI-HF trial have indicated that, in patients with chronic HF on evidence-based therapy, long term treatment with PUFAs reduced mortality and hospitalizations for cardiovascular reasons, irrespective of etiology and left ventricular (LV) ejection fraction (EF). The purpose of this review is to summarize the evidence emerged from studies conducted so far on the effect of n-3 PUFAs in HF.
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Affiliation(s)
- Savina Nodari
- Section of Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy.
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6
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Teng LL, Shao L, Zhao YT, Yu X, Zhang DF, Zhang H. The beneficial effect of n-3 polyunsaturated fatty acids on doxorubicin-induced chronic heart failure in rats. J Int Med Res 2010; 38:940-8. [PMID: 20819430 DOI: 10.1177/147323001003800320] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study was designed to assess the effects of dietary supplementation with n-3 polyunsaturated fatty acids (PUFA) from fish oil on the response of doxorubicin-induced chronic heart failure in rats. Male Sprague-Dawley rats were treated daily for 8 weeks with normal saline or n-3 PUFA intragastrically after induction of myocardial injury by intraperitoneal injection of doxorubicin 2 mg/kg once weekly for 8 weeks. Cardiac function was assessed by echocardiography. The cytoprotective role of n-3 PUFA against doxorubicin-induced myocardial injury was demonstrated by light microscopy, and serum cytokines (tumour necrosis factor-alpha and interleukin-10) were analysed by enzyme-linked immunosorbent assay. Doxorubicin induced death, alterations in echocardiography parameters and histological damage, all of which are features that characterize heart failure. There were significant differences between the doxorubicin-induced heart failure group and the n-3 PUFA-treated group in terms of echocardiography parameters and cytokine changes. Thus, dietary supplementation with n-3 PUFA attenuated doxorubicin-induced cardiac dysfunction, an effect that might be associated with recovery from an imbalance of the cytokine network.
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Affiliation(s)
- L L Teng
- Department of Geratology, Shanghai East Hospital, Tongji University, Shanghai, China
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7
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Mubarak KK. A review of prostaglandin analogs in the management of patients with pulmonary arterial hypertension. Respir Med 2010; 104:9-21. [DOI: 10.1016/j.rmed.2009.07.015] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 06/25/2009] [Accepted: 07/19/2009] [Indexed: 10/20/2022]
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8
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Duda MK, O'Shea KM, Stanley WC. omega-3 polyunsaturated fatty acid supplementation for the treatment of heart failure: mechanisms and clinical potential. Cardiovasc Res 2009; 84:33-41. [PMID: 19474179 DOI: 10.1093/cvr/cvp169] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Heart failure (HF) is a complex clinical syndrome with multiple aetiologies. Current treatment options can slow the progression to HF, but overall the prognosis remains poor. Clinical studies suggest that high dietary intake of the omega-3 polyunsaturated fatty acids (omega-3PUFA) found in fish oils (eicosapentaenoic and docosahexaenoic acids) may lower the incidence of HF, and that supplementation with pharmacological doses prolongs event-free survival in patients with established HF. The mechanisms for these potential benefits are complex and not well defined. It is well established that fish oil supplementation lowers plasma triglyceride levels, and more recent work demonstrates anti-inflammatory effects, including reduced circulating levels of inflammatory cytokines and arachidonic acid-derived eicosanoids, and elevated plasma adiponectin. In animal studies, fish oil favourably alters cardiac mitochondrial function. All of these effects may work to prevent the development and progression of HF. The omega-3PUFA found in plant sources, alpha-linolenic acid, may also be protective in HF; however, the evidence is not as compelling as for fish oil. This review summarizes the evidence related to use of omega-3PUFA supplementation as a potential treatment for HF and discusses possible mechanisms of action. In general, there is growing evidence that supplementation with omega-3PUFA positively impacts established pathophysiological targets in HF and has potential therapeutic utility for HF patients.
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Affiliation(s)
- Monika K Duda
- Department of Clinical Physiology, Medical Centre of Postgraduate Education, Warsaw, Poland
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9
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Spinarova L, Vitovec J. Neurohumoral changes in chronic heart failure. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2008; 151:201-7. [PMID: 18345252 DOI: 10.5507/bp.2007.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Humoral systems play an important role in the pathophysiology and development of chronic heart failure (CHF). METHODS We conducted a search of neurohumoral activation in heart failure and its risk in the development of CHF. RESULTS AND CONCLUSION Neurohumoral factors may be divided into vasoconstrictive, vasodilative and cytokines. The main vasoconstrictive systems are the renin-angiotensin-aldosterone system (RAAS) and the sympathoadrenal system (SAS). Cytokines include tumour necrosis factor (TNF) alpha and interleukins. The systems of actions are interconnected and they mutually influence their secretion and activities. The possibilities of their detection and assessment for clinical purposes depend on their changes and kinetics in the organism and on the activity of individual metabolites. Apart from their vasoactive effects, the majority of humoral actions also interfere in the process of remodelling, function of the endothelium, blood elements, cardiomyocytes, cells of the smooth muscles, and in immunity as well as inflammatory processes. The rapid development of knowledge on the humoral actions in recent years has made possible their utilisation in diagnostics, treatment and prognosis.
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Affiliation(s)
- Lenka Spinarova
- 1st Internal Cardioangiologic Department, Medical Faculty of Masaryk University, Brno, Czech Republic.
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10
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Duda MK, O'Shea KM, Tintinu A, Xu W, Khairallah RJ, Barrows BR, Chess DJ, Azimzadeh AM, Harris WS, Sharov VG, Sabbah HN, Stanley WC. Fish oil, but not flaxseed oil, decreases inflammation and prevents pressure overload-induced cardiac dysfunction. Cardiovasc Res 2008; 81:319-27. [PMID: 19015135 DOI: 10.1093/cvr/cvn310] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS Clinical studies suggest that intake of omega-3 polyunsaturated fatty acids (omega-3 PUFA) may lower the incidence of heart failure. Dietary supplementation with omega-3 PUFA exerts metabolic and anti-inflammatory effects that could prevent left ventricle (LV) pathology; however, it is unclear whether these effects occur at clinically relevant doses and whether there are differences between omega-3 PUFA from fish [eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)] and vegetable sources [alpha-linolenic acid (ALA)]. METHODS AND RESULTS We assessed the development of LV remodelling and pathology in rats subjected to aortic banding treated with omega-3 PUFA over a dose range that spanned the intake of humans taking omega-3 PUFA supplements. Rats were fed a standard food or diets supplemented with EPA+DHA or ALA at 0.7, 2.3, or 7% of energy intake. Without supplementation, aortic banding increased LV mass and end-systolic and -diastolic volumes. ALA supplementation had little effect on LV remodelling and dysfunction. In contrast, EPA+DHA dose-dependently increased EPA and DHA, decreased arachidonic acid in cardiac membrane phospholipids, and prevented the increase in LV end-diastolic and -systolic volumes. EPA+DHA resulted in a dose-dependent increase in the anti-inflammatory adipokine adiponectin, and there was a strong correlation between the prevention of LV chamber enlargement and plasma levels of adiponectin (r = -0.78). Supplementation with EPA+DHA had anti-aggregatory and anti-inflammatory effects as evidenced by decreases in urinary thromboxane B(2) and serum tumour necrosis factor-alpha. CONCLUSION Dietary supplementation with omega-3 PUFA derived from fish, but not from vegetable sources, increased plasma adiponectin, suppressed inflammation, and prevented cardiac remodelling and dysfunction under pressure overload conditions.
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Affiliation(s)
- Monika K Duda
- Division of Cardiology, Department of Medicine, University of Maryland-Baltimore, 20 Penn Street, HSF2, Room S022, Baltimore, MD 21201, USA
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11
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12
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Rolin S, Masereel B, Dogné JM. Prostanoids as pharmacological targets in COPD and asthma. Eur J Pharmacol 2006; 533:89-100. [PMID: 16458293 DOI: 10.1016/j.ejphar.2005.12.058] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2005] [Accepted: 12/13/2005] [Indexed: 11/22/2022]
Abstract
COPD (Chronic Obstructive Pulmonary Disease) and bronchial asthma are two severe lung diseases which represent a major problem of world public health. Leukotrienes and prostanoids play an important role in the pathogenesis of pulmonary diseases. Prostanoids: prostaglandins (PGs) and thromboxane A2 (TXA2), the cyclooxygenase metabolites of arachidonic acid are implicated in the inflammatory cascade that occurs in asthmatic airways. Recently, the roles played by isoprostanes or prostaglandin-like compounds nonenzymatically generated via peroxidation of membrane phospholipids by reactive oxygen species, in particular F2-isoprostanes, in pulmonary pathophysiology have been highlighted. This article aims to provide an overview of the role of prostanoids and isoprostanes in the pathogenesis of COPD and asthma and to discuss the pharmacological strategies developed in prevention and/or treatment of these pathologies.
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MESH Headings
- Animals
- Asthma/drug therapy
- Asthma/metabolism
- Benzoquinones/pharmacology
- Benzoquinones/therapeutic use
- Carbazoles/pharmacology
- Carbazoles/therapeutic use
- Enzyme Inhibitors/pharmacology
- Enzyme Inhibitors/therapeutic use
- F2-Isoprostanes/metabolism
- Heptanoic Acids/pharmacology
- Heptanoic Acids/therapeutic use
- Humans
- Methacrylates/pharmacology
- Methacrylates/therapeutic use
- Prostaglandin Antagonists/pharmacology
- Prostaglandin Antagonists/therapeutic use
- Prostaglandin D2/metabolism
- Pulmonary Disease, Chronic Obstructive/drug therapy
- Pulmonary Disease, Chronic Obstructive/metabolism
- Randomized Controlled Trials as Topic
- Receptors, Immunologic/antagonists & inhibitors
- Receptors, Immunologic/metabolism
- Receptors, Prostaglandin/antagonists & inhibitors
- Receptors, Prostaglandin/metabolism
- Receptors, Thromboxane A2, Prostaglandin H2/antagonists & inhibitors
- Receptors, Thromboxane A2, Prostaglandin H2/metabolism
- Sulfonamides/pharmacology
- Sulfonamides/therapeutic use
- Thromboxane A2/metabolism
- Thromboxane-A Synthase/antagonists & inhibitors
- Thromboxane-A Synthase/metabolism
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Affiliation(s)
- Stéphanie Rolin
- Department of Pharmacy, University of Namur, Rue de Bruxelles 61, B-5000 Namur, Belgium
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13
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Hata AN, Breyer RM. Pharmacology and signaling of prostaglandin receptors: multiple roles in inflammation and immune modulation. Pharmacol Ther 2005; 103:147-66. [PMID: 15369681 DOI: 10.1016/j.pharmthera.2004.06.003] [Citation(s) in RCA: 599] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Prostaglandins are lipid-derived autacoids that modulate many physiological systems including the CNS, cardiovascular, gastrointestinal, genitourinary, endocrine, respiratory, and immune systems. In addition, prostaglandins have been implicated in a broad array of diseases including cancer, inflammation, cardiovascular disease, and hypertension. Prostaglandins exert their effects by activating rhodopsin-like seven transmembrane spanning G protein-coupled receptors (GPCRs). The prostanoid receptor subfamily is comprised of eight members (DP, EP1-4, FP, IP, and TP), and recently, a ninth prostaglandin receptor was identified-the chemoattractant receptor homologous molecule expressed on Th2 cells (CRTH2). The precise roles prostaglandin receptors play in physiologic and pathologic settings are determined by multiple factors including cellular context, receptor expression profile, ligand affinity, and differential coupling to signal transduction pathways. This complexity is highlighted by the diverse and often opposing effects of prostaglandins within the immune system. In certain settings, prostaglandins function as pro-inflammatory mediators, but in others, they appear to have anti-inflammatory properties. In this review, we will discuss the pharmacology and signaling of the nine known prostaglandin GPCRs and highlight the specific roles that these receptors play in inflammation and immune modulation.
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MESH Headings
- Humans
- Inflammation/metabolism
- Phylogeny
- Prostaglandins/physiology
- Receptors, Epoprostenol/genetics
- Receptors, Epoprostenol/metabolism
- Receptors, Immunologic/genetics
- Receptors, Immunologic/metabolism
- Receptors, Prostaglandin/genetics
- Receptors, Prostaglandin/metabolism
- Receptors, Prostaglandin E/genetics
- Receptors, Prostaglandin E/metabolism
- Receptors, Thromboxane A2, Prostaglandin H2/genetics
- Receptors, Thromboxane A2, Prostaglandin H2/metabolism
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Affiliation(s)
- Aaron N Hata
- Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, TN, USA
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14
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Gerrah R, Izhar U. Beneficial effect of aspirin on renal function post-cardiopulmonary bypass. Asian Cardiovasc Thorac Ann 2004; 11:304-8. [PMID: 14681089 DOI: 10.1177/021849230301100407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Urine thromboxane, plasma creatinine, and creatinine clearance were determined perioperatively in 20 patients undergoing coronary bypass surgery. Ten patients took aspirin until the day of surgery, and 10 discontinued aspirin at least one week before surgery. A significant increase in urine thromboxane following establishment of cardiopulmonary bypass was observed only in the control group. Plasma creatinine increased in the control group on the 1st postoperative day (from 81.9 +/- 13.2 to 97.6 +/- 13.2 micromol.L(-1), p = 0.02) and decreased next day to the preoperative level (82.7 +/- 9 micromol.L(-1), p = 0.03). In the aspirin group, creatinine remained unchanged on the 1st postoperative day (89.4 +/- 14.2 vs. 87.2 +/- 7.7 micromol.L(-1), p = 0.6), and increased significantly on the 2nd day (101.4 +/- 8.5 micromol.L(-1), p = 0.01). The aspirin group had higher creatinine levels (p < 0.0001) and lower creatinine clearance (60.2 +/- 16.5 vs. 82 +/- 25.7 mL.min(-1), p < 0.0001) than the control group on the 2nd postoperative day. A significant positive correlation was seen between urine thromboxane and creatinine on day 2 in both groups (r = 0.6). Aspirin administrated before coronary surgery may have a beneficial effect on renal function, probably mediated by its antiplatelet activity and thromboxane inhibition.
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Affiliation(s)
- Rabin Gerrah
- Department of Cardiothoracic Surgery, Hebrew University-Hadassah Medical School, PO Box 12000, Jerusalem 91120, Israel.
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15
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Castellani S, Paniccia R, Di Serio C, La Cava G, Poggesi L, Fumagalli S, Gensini GF, Neri Serneri GG. Thromboxane inhibition improves renal perfusion and excretory function in severe congestive heart failure. J Am Coll Cardiol 2003; 42:133-9. [PMID: 12849673 DOI: 10.1016/s0735-1097(03)00511-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate whether thromboxane inhibition can favorably affect renal perfusion and clinical conditions in patients affected by severe heart failure. BACKGROUND The renal formation of the vasoconstrictor thromboxane A(2) (TxA(2)) is increased during cardiac failure. METHODS By oral administration of picotamide (a renal TxA(2) synthase and TxA(2)/prostaglandin H(2) receptor inhibitor), we blocked renal TxA(2). Fourteen patients in New York Heart Association functional class IV were studied according to a randomized, double-blinded, cross-over design. Each of the two eight-day periods of testing was preceded by a three-day period during which certain vasoactive medications were stopped. RESULTS Daily 24-h total urinary thromboxane B(2) (TxB(2)), the stable metabolite of TxA(2), dropped at the end of picotamide treatment (p < 0.01 vs. baseline). Compared with placebo, effective renal plasma flow and the glomerular filtration rate increased (p < 0.01 and p < 0.05, respectively), thus leading to a significant decrease in the filtration fraction (p < 0.01). Renal vascular resistance decreased consistently (p < 0.01). In all patients, picotamide treatment was associated with an increase in diuresis and natriuresis (p < 0.001 vs. baseline). Plasma creatinine decreased (p < 0.05 vs. baseline). Patients also showed improvement in several clinical parameters, including a significant decrease in both pulmonary and venous pressure (p < 0.01 vs. baseline). CONCLUSIONS These results indicate that renal thromboxane formation plays an important role in renal vascular resistance in patients with severe heart failure, such as those described in the present study. Inhibition of TxA(2) improves renal hemodynamics and kidney function and favorably affects indexes of cardiac performance.
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Affiliation(s)
- Sergio Castellani
- Sezione Clinica Medica Generale e Cardiologia, Universita degli Studi di Firenze, Viale Morgagni 85, 50134 Florence, Italy.
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16
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Abstract
Renal cyclooxygenase 1 and 2 activity produces five primary prostanoids: prostaglandin E2, prostaglandin F2alpha, prostaglandin I2, thromboxane A2, and prostaglandin D2. These lipid mediators interact with a family of distinct G protein-coupled prostanoid receptors designated EP, FP, IP, TP, and DP, respectively, which exert important regulatory effects on renal function. The intrarenal distribution of these prostanoid receptors has been mapped, and the consequences of their activation have been partially characterized. FP, TP, and EP1 receptors preferentially couple to an increase in cell calcium. EP2, EP4, DP, and IP receptors stimulate cyclic AMP, whereas the EP3 receptor preferentially couples to Gi, inhibiting cyclic AMP generation. EP1 and EP3 mRNA expression predominates in the collecting duct and thick limb, respectively, where their stimulation reduces NaCl and water absorption, promoting natriuresis and diuresis. The FP receptor is highly expressed in the distal convoluted tubule, where it may have a distinct effect on renal salt transport. Although only low levels of EP2 receptor mRNA are detected in the kidney and its precise intrarenal localization is uncertain, mice with targeted disruption of the EP2 receptor exhibit salt-sensitive hypertension, suggesting that this receptor may also play an important role in salt excretion. In contrast, EP4 receptor mRNA is predominantly expressed in the glomerulus, where it may contribute to the regulation of glomerular hemodynamics and renin release. The IP receptor mRNA is highly expressed near the glomerulus, in the afferent arteriole, where it may also dilate renal arterioles and stimulate renin release. Conversely, TP receptors in the glomerulus may counteract the effects of these dilator prostanoids and increase glomerular resistance. At present there is little evidence for DP receptor expression in the kidney. These receptors act in a concerted fashion as physiological buffers, protecting the kidney from excessive functional changes during periods of physiological stress. Nonsteroidal anti-inflammatory drug (NSAID)-mediated cyclooxygenase inhibition results in the loss of these combined effects, which contributes to their renal effects. Selective prostanoid receptor antagonists may provide new therapeutic approaches for specific disease states.
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Affiliation(s)
- M D Breyer
- Division of Nephrology, Department of Medicine, Vanderbilt University, Nashville, Tennessee 37232, USA.
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Abstract
Cyclooxygenases metabolize arachidonate to five primary prostanoids: PGE(2), PGF(2 alpha), PGI(2), TxA(2), and PGD(2). These autacrine lipid mediators interact with specific members of a family of distinct G-protein-coupled prostanoid receptors, designated EP, FP, IP, TP, and DP, respectively. Each of these receptors has been cloned, expressed, and characterized. This family of eight prostanoid receptor complementary DNAs encodes seven transmembrane proteins which are typical of G-protein-coupled receptors and these receptors are distinguished by their ligand-binding profiles and the signal transduction pathways activated on ligand binding. Ligand-binding selectivity of these receptors is determined by both the transmembrane sequences and amino acid residues in the putative extracellular-loop regions. The selectivity of interaction between the receptors and G proteins appears to be mediated at least in part by the C-terminal tail region. Each of the EP(1), EP(3), FP, and TP receptors has alternative splice variants described that alter the coding sequence in the C-terminal intracellular tail region. The C-terminal variants modulate signal transduction, phosphorylation, and desensitization of these receptors, as well as altering agonist-independent constitutive activity.
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Affiliation(s)
- R M Breyer
- Division of Nephrology, Department of Medicine, Vanderbilt University, Nashville, Tennessee 37232, USA.
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18
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Stanke-Labesque F, Cracowski JL, Bedouch P, Chavanon O, Magne JL, Bessard G, Devillier P. Furosemide inhibits thromboxane A2-induced contraction in isolated human internal mammary artery and saphenous vein. J Cardiovasc Pharmacol 2000; 35:531-7. [PMID: 10774781 DOI: 10.1097/00005344-200004000-00003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Evidence suggests that, in addition to its diuretic property, furosemide also may exert direct vascular effects. Because thromboxane A2 (TXA2) has a role in the control of vascular tone, we investigated the effect of furosemide on the contraction induced by U46619 (a stable TXA2 mimetic) on isolated human internal mammary artery (IMA) and saphenous vein (SV). Concentration-response curves to U46619 were performed in the absence (vehicle) or the presence of furosemide (0.1-1 mM) on rings of IMA and SV. In addition, the relaxant effect of furosemide (0.1 microM-1 mM) also was evaluated on U46619-precontracted IMA and SV. The participation of cyclooxygenase derivatives was studied by pretreatment with indomethacin. Furosemide (0.1-1.0 mM) caused parallel rightward shifts of U46619 concentration-response curves without affecting the maximal responses in both IMA and SV. Treatment with indomethacin (1 microM) modified neither the inhibitory effect of furosemide on U46619-induced contractions, nor the relaxant effect of furosemide on U46619-induced contractions, nor the relaxant effect of furosemide on U46619-precontracted IMA and SV. In conclusion, furosemide at high concentrations inhibited U46619-induced contraction in human isolated IMA and SV and relaxed U46619-precontracted IMA and SV by mechanisms independent of the release of relaxant prostaglandins. These results suggest that blockade of TXA2 receptors by furosemide may contribute to explaining the therapeutic effects of furosemide in the treatment of severe heart failure.
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Affiliation(s)
- F Stanke-Labesque
- Laboratory of Pharmacology, Faculté de Médecine de Grenoble, France.
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19
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Licker M, Schweizer A, Höhn L, Morel DR. Chronic angiotensin converting inhibition does not influence renal hemodynamic and function during cardiac surgery. Can J Anaesth 1999; 46:626-34. [PMID: 10442956 DOI: 10.1007/bf03013949] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE Treatment with angiotensin-converting enzyme (ACE) inhibitors affects the autoregulation of renal blood flow and glomerular filtration and provides renal protective effects. The purpose of this case-control study was to investigate the effects of chronic ACE inhibition on perioperative renal hemodynamics and function. METHOD We prospectively studied renal function in two groups of patients, chronically treated or not, with ACE inhibitors (ACEI and control; n = 16, in each group) who underwent elective cardiac surgery under hypothermic cardiopulmonary bypass. Glomerular filtration rate, effective renal plasma flow, osmolar clearance and fractional excretion of sodium and potassium were determined before, during and after CPB. Additional measurements included plasma atrial natriuretic factor (ANF) as well as plasma and urinary cyclic GMP (cGMP), thromboxane B2 (TxB2) and 6-keto-PGF1. RESULTS Renal functional and hemodynamic variables did not differ between the two groups, at any period. Cardiopulmonary bypass induced increases in urinary flow, osmolar clearance and fractional excretion of sodium and potassium in both groups. Plasma and urinary ratio of 6-keto-PGF to TxB2 increased markedly and reflected a predominant systemic and renal release of vasodilatory prostaglandins. Intraoperatively, ANF was higher in ACEIs than in control patients. CONCLUSIONS Long term treatment with ACE inhibitors does not influence the perioperative changes in renal hemodynamics and function. During cardiopulmonary bypass, a transient impairment in solute reabsorption is associated with renal release of vasodilatory mediators (nitric oxide and prostacyclin).
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Affiliation(s)
- M Licker
- Division of Anesthesiology, Hôpital Cantonal Universitaire, Geneve, Switzerland.
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20
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Bergdahl A, Valdemarsson S, Nilsson T, Sun XY, Hedner T, Edvinsson L. Dilatory responses to acetylcholine, calcitonin gene-related peptide and substance P in the congestive heart failure rat. ACTA PHYSIOLOGICA SCANDINAVICA 1999; 165:15-23. [PMID: 10072092 DOI: 10.1046/j.1365-201x.1999.00456.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It was examined to what extent congestive heart failure (CHF) in rats, induced by ligation of the left coronary artery, affects the vascular responses to the vasodilatory substances acetylcholine (ACh), calcitonin gene-related peptide (CGRP), and substance P (SP). After induction of CHF status, the basilar, mesenteric and renal arteries and the iliac vein were studied in vitro. Dilatory responses were determined in relation to pre-contraction by the thromboxane mimetic U46619. Sham-operated animals (Sham) served as controls. U46619 induced stronger contraction in CHF basilar and renal arteries compared with the corresponding segments in Sham. ACh induced concentration-dependent dilations in all vessels examined with no difference of maximum relaxation or potency between CHF and Sham. SP induced weak dilations in all arteries examined while the response was markedly attenuated in CHF iliac veins compared with Sham (Emax% 12.2 +/- 3.4 vs. 32.3 +/- 4.8, P = 0.01). The CGRP induced dilation in the CHF basilar artery was weaker (Emax% 18.6 +/- 6.5 vs. 66.9 +/- 5.0, P < 0.001) and less potent (pEC50: 8.2 +/- 0.2 vs. 9.0 +/- 0.2, P = 0.01) compared with Sham. Further, CGRP was less potent in the renal artery of CHF rats compared with Sham (pEC50: 8.1 +/- 0.2 vs. 9.5 +/- 0.3, P < 0.01). In the CHF iliac vein, CGRP was more potent compared with Sham (pEC50: 9.7 +/- 0.4 vs. 8.3 +/- 0.4, P < 0.05). It can be concluded CHF is accompanied by alterations in the vascular response to the dilatory substances studied. The changes differ between vascular beds and between the different substances.
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Affiliation(s)
- A Bergdahl
- Department of Internal Medicine, Lund University, Sweden
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21
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Bergdahl A, Nilsson T, Sun XY, Hedner T, Edvinsson L. Altered neuropeptide Y Y1 responses in mesenteric arteries in rats with congestive heart failure. Eur J Pharmacol 1998; 360:165-73. [PMID: 9851583 DOI: 10.1016/s0014-2999(98)00655-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of the present study was to elucidate if the potentiating effect of neuropeptide Y on various vasoactive agents in vitro is (1) altered in mesenteric arteries from rats with congestive heart failure and (2) mediated by the neuropeptide Y Y1 receptor. The direct vascular effects of neuropeptide Y and its modulating effects on the contractions induced by endothelin-1-, noradrenaline-, 5-hydroxytryptamine (5-HT)-, U46619-(9,11-dideoxy-11alpha, 9alpha-epoxymethano-prostaglandin F2alpha) and ATP, and acetylcholine-induced dilatations were studied in the presence and absence of the neuropeptide Y Y1 antagonist, BIBP3226 (BIBP3226¿(R)-N2-(diphenylacetyl)-N-[(4-hydroxyphenyl)methyl ]-D-arginine-amide¿). Neuropeptide Y, per se, had no vasoactive effect in the arteries. The potency of endothelin-1 was significantly decreased in congestive heart failure rats. Neuropeptide Y and neuropeptide Y-(13-36) potentiated the endothelin-1-induced contraction in congestive heart failure mesenteric arteries. In 20% of the congestive heart failure rats, sarafotoxin 6c induced a contraction of 31+/-4%. Neuropeptide Y also potentiated U46619- and noradrenaline-induced contractions but not 5-HT-induced contractions in congestive heart failure arteries. In sham-operated animals neuropeptide Y potentiated noradrenaline- and 5-HT-induced contractions. These potentiations were inhibited by BIBP3226. Acetylcholine induced an equipotent relaxation in both groups which was unaffected by neuropeptide Y. In conclusion, neuropeptide Y responses are altered in congestive heart failure rats. The potentiating effect differs between vasoactive substances. Neuropeptide Y Y1 and non-neuropeptide Y1 receptors are involved.
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Affiliation(s)
- A Bergdahl
- Department of Internal Medicine, Lund University Hospital, Sweden.
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Spinarová L, Toman J, Pospísilová J, Souĉek M, Kára T, Stejfa M. Humoral response in patients with chronic heart failure. Int J Cardiol 1998; 65:227-32. [PMID: 9740478 DOI: 10.1016/s0167-5273(98)00116-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM Correlation of five humoral markers with laboratory, echocardiographic and right heart catheterization parameters in patients with chronic heart failure. STUDY POPULATION 29 patients, heart failure NYHA II and III, ejection fraction below 40% with coronary artery disease or dilated cardiomyopathy. METHODS evaluation of thromboxane, prostaglandin F (PGF), tumor necrosis factor (TNF) alpha, endothelin-1 and big endothelin rest levels and their correlation with: (1) laboratory parameters: Sodium, urea, creatinine, fibrinogen, (2) chest X-ray: cardiothoracic index (CTI), pulmonary congestion, (3) right heart catheterization parameters at rest, hand-grip and bicycle ergometry: mean pulmonary artery pressure (AP), wedge pressure (WP), systemic and pulmonary vascular resistance (SVR, PVR) and cardiac index (CI), (4) echocardiographic parameters at rest, hand-grip and bicycle ergometry: end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), mitral flow E/A, filling period of left ventricle and time of duration of mitral regurgitation. RESULTS No correlation was found between thromboxane, prostaglandin F and tumor necrosis factor alpha with the above mentioned parameters. Endothelin-1 level correlated with E/A, PVR and MPA at rest and at hand-grip. Big endothelin level correlated with EDV and ESV, AP, WP and SVR at rest and at both types of exercise. The highest correlation was between big endothelin and rest AP (r=0.79), rest WP (r=0.78) and CTI (r=0.58), all P<0.01. CONCLUSIONS Big endothelin and partly endothelin-1 levels showed a close correlation with some parameters used for the evaluation of chronic heart failure severity.
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Affiliation(s)
- L Spinarová
- 1st Internal Department, Masaryk University, Brno, Czech Republic
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