Prostaglandin D2 as a potential antithrombotic agent

Prostaglandin D₂ was found to be a potent inhibitor of platelet aggregation. Aggregation of human platelets by ADP, collagen and prostaglandin G₂ was inhibited more strongly by PGD₂ than by PGE₁. Although ADP-induced aggregation of rabbit platelets was inhibited more strongly by PGE₁ than by PGD₂ the latter prostaglandin gave a more long-lasting inhibitory effect on platelet aggregation following intravenous or oral administration. These results coupled with the finding that PGD₂ has less hypotensive effects on the cardiovascular system than PGE₁ suggest the possible use of PGD₂ as an antithrombotic agent.     

Influences of prostaglandins on electrophoretic mobility and aggregation of rabbit platelets

Influences of prostaglandin(PG)s on electrophoretic mobilities and aggregation of rabbit platelets were studied. The PGs studied (PGI₂, PGE₁, PGD₂, PGE₂, PGF_2α, PGA₂ and PGA₁) had no effect on platelet electrophoretic mobility. However, both PGE₁ and PGI₂ in 0.3 and 3.0 μM inhibited ADP-induced aggregation and ADP-induced decrease in the mobility. PGD₂ in 0.3 and 3.0, and PGE₂ in 30 μM inhibited the aggregation but did not depress the ADP-induced decrease in the mobility. PGF_2α, PGA₂ and PGA₁ had no effect on the decrease in electrophoretic mobility and on the aggregation caused by ADP.     

Comparison of the effects of prostacyclin (PGI2), prostaglandin E1 and D2 on platelet aggregation in different species

The activity of prostacyclin (PGI₂), PGE₁ or PGD₂ as inhibitors of platelet aggregation in plasma from human, dog, rabbit, rat, sheep and horse was investigated. Prostacyclin was the most potent inhibitor in all species. PGD₂ was a weak inhibitor in dog, rabbit and rat plasma whereas PGE₁ and prostacyclin were highly active. Theophylline or dipyridamole potentiated the inhibition of human platelet aggregation by prostacyclin, PGE₁ or PGD₂. Compound N-0164 abolished the inhibition by PGD₂ of human platelet aggregation but did not inhibit the effects of PGE₁ or prostacyclin. The results suggest that prostacyclin and PGE₁ act on similar sites on platelets which are distinct from those for PGD₂.     

Agonist regulation of the human platelet prostaglandin D2 receptor.

The effect of exposing platelets to prostaglandin D₂ (PGD₂) on hormone binding was studied. Incubation of platelets with PGD₂ for 2 hr resulted in a decrease in [³H]PGD₂ binding that was dose dependent. Inhibition of binding was 14% after incubation with 10^?8M PGD₂, 19% after incubation with 10^?7M PGD₂, and 40% after exposure to 10^?6M PGD₂. This decreased binding (desensitization) was specific for [³H]PGD₂ as binding to platelets by [³H]PGE₁ and the α-adrenergic antagonist [³H] dihydroergocryptine (DHEC) was comparable to control platelets. Saturation of [³]PGD₂ binding to desensitization platelets was at 27 fmole ligand/10⁸ platelets compared to 43 fmoles/10⁸ platelets in control platelets. Half-maximal saturation occured at 20 nM PGD₂ both for desensitized and control platelets, suggesting that decreased binding sites rather than altered affinity between ligand and receptor accounted for these results. These platelets had a partial increase in [³H]PGD₂ binding a few hours after plasma was washed free of PGD₂ with complete resensitization after 24 hr. Since prostaglandins such as PGI₂, PGD₂, and PGE₁ are potent inhibitors of platelet aggregation, decreased binding of platelets to these hormones after prostaglandin exposure may provide a mechanism for altered responsiveness of platelets to aggregating stimuli.     

Desensitization of prostaglandin-activated platelet adenylate cyclase

Prostaglandin D₂ (PGD₂) is one of several prostaglandins that can inhibit platelet aggregation and activate adenylate cyclase. Platelets were exposed to varying concentrations of PGD₂, washed, and the adenylate cyclase response to prostaglandins, epinephrine, and sodium fluoride determined. Incubating platelets with 5 × 10^?5 M PGD₂ for 2 hr resulted in a 45% decrease in PGD₂ activation of adenylate cyclase and a 25% decrease in stimulation by PGE₁. Fluoride activation (7-fold) epinephrine inhibition (30%) and basal enzyme activity were unchanged by exposure of the platelets to PGD₂. Desensitization was concentration dependent, with loss of enzyme activity first noted when platelets were incubated with 10^?7 M PGD₂. Enzyme sensitivity could be partially restored when desensitized platelets were washed free of PGD₂ and incubated in buffer for 2 hr; complete resensitization required incubation for 24 hr in plasma. Regulation of prostaglandin sensitive platelet adenylate cyclase could be of importance in mediating the response of platelets to aggregating agents.     

Effects of all CIS-5, 8,11,14,17 eicosapentaenoic acid and PGH3 on platelet aggregation

In human platelet-rich plasma (PRP) eicosapentaenoic acid (EPA) inhibited platelet aggregation induced by a stable analogue of PGH₂ (U46619), arachidonic acid, collagen or ADP. EPA was more potent than oleic, linoleic, α-linolenic or γ-linolenic acids. In aspirin-treated platelets, aggregation induced by U46619 was inhibited to a similar extent by arachidonic acid or by EPA over a range of concentrations of 0.05–0.3 mM. EPA incubated with PRP did not induce the generation of a thromboxane (TXA)-like activity; indeed it prevented the formation of TXA₂ induced by arachidonic acid or by collagen. The anti-aggregatory activity of EPA was not influenced by inhibitors of cyclo-oxygenase and lipoxygenase. The anti-aggregatory action of EPA may be caused by a rapid occupancy by EPA of TXA₂/PGH₂ “receptors” on platelet membrane as well as by a slower displacement of arachidonic acid from platelet phospholipids by chemically unchanged molecules of EPA.Not all samples of PRP were irreversibly aggregated by PGH₂, but in those that were, PGH₃ also induced an immediate dose-dependent but reversible aggregation. After a 4 min incubation of non-aggregating doses of PGH₂ or PGH₃ (100–300 nM) with PRP a stable anti-aggregatory compound was detected. The inhibitory activity produced from PGH₃ was apparently more potent (ca 10 times) than that obtained from PGH₂. The anti-aggregating compounds were identified by TLC and GLC-MS as PGD₂ and PGD₃. The apparent difference of potency between PGD₂ and PGD₃ was attributed to the concurrent production of PGE₂ and PGE₃. PGE₂ prevented the inhibitory effect of PGD₂ whereas PGE₃ did not affect the activity of PGD₃.It is concluded that one of the reasons for the low incidence of myocardial infarction in Eskimos could be that the pro-aggregatory arachidonic acid is replaced in their phospholipids by the anti-aggregatory EPA.     

Biosynthesis of prostaglandin D2 1. Formation of prostaglandin D2 by human platelets

Formation of prostaglandin D₂ (PGD₂) during the aggregation of platelets was determined, employing a specific bioassay. PGD₂ was synthesized in human platelet rich plasma (PRP) in response to thrombin, collagen and epinephrine. Indomethacin pretreatment abolished the biosynthesis of PGD₂. When thrombin treated PRP was incubated for different periods of time and denatured in the presence of SnCl₂ to prevent the formation of PGD₂ from endoperoxides during the extraction procedure, PGD₂ formation was noted within the first minute of incubation and reached a peak level after 4 minutes. PGD₂ from thrombin stimulated PRP was conclusively identified by gas chromatography-mass spectrometry.The formation of PGD₂ during platelet aggregation could represent a mechanism of feedback inhibition of aggregation.     

Inhibition of PGE1-stimulated cAMP accumulation in human platelets by thromboxane A2

The prostaglandin endoperoxide PGH₂, HHT, HETE, thromboxane A₂, and thromboxane B₂, which are all products of arachidonic acid metabolites of human platelets, were tested for their ability to modulate platelet cyclic nucleotide levels. None of the compounds tested altered the basal level of cAMP or cGMP, and only PGH₂ and thromboxane A₂ inhibited PGE₁-stimulated cAMP accumulation. Thromboxane A₂ was found to be a more potent inhibitor of PGE₁-stimulated cAMP accumulation and inducer of platelet aggregation thatn PHG₂.     

Platelet and cardiovascular activity of the hydantoin BW245C, a potent prostaglandin analogue

The platelet anti-aggregating, cardiovascular and gastro-intestinal actions of a hydantoin prostaglandin analogue, BW245C have been compared with prostaglandin and PGD₂ several species. In human plasma , BW245C was 0.2 times as active as prostacyclin and 8 times as active as PGD₂ in inhibiting platelet aggregation. In rat and rabbit plasma, BW245C was only weakly active but was more potent in sheep and horse plasma. Since the acivity of PGD₂ varied in a parallel fashion, BW245C may interactive with PGD₂ binding sites on platelets. The potency of BW245C as a vasodepressor also varied between species, being 0.5, 0.1, 0.06 and < 0.02 times as active as prostacyclin in the aneasthetised dog, monkey, rat and rabbit respectively.The relative activity of BW245C as an inhibitor of platelet aggregation was more comparable, being 0.08, 0.04 and 0.05 times as active as prostacyclin following intravenous infusion in the rabbit dog and monkey respectively. In the rabbit, BW245C was a highly selective platelet inhibitor with minimal cardiovascular actions, whereas in the dog and monkey, BW245C lowered BP in anti-aggregating doses. The potent platlet anti-aggregating actions of BW245C following parenteral or oral administration makes this hydantoin a potentially-useful anti-thrombotic prostaglandin analogue.     

Manipulation of platelet aggregation by prostaglandins and their fatty acid precursors: Pharmacological basis for a therapeutic approach

Addition of the one-, two- or three- series endoperoxide to human platelet-rich plasma tend to supress aggregation, through the action of their respective non-enzymatic breakdown products PGE₁, PGD₂, or PGD₃ all of which elevate cyclic AMP levels. On the other hand, these stable primary products do not arise in appreciable amounts from intrinsic endoperoxides generated from either endogenous or exogenous free fatty acids. 5,8,11,14,17-Eicosapentaenoic acid (EPA) suppresses arachidonic acid (5,8,11,14-eicosatetraenoic acid) conversion by cycloogygenase (as well as lipoxygenase) to aggregatory metabolites in platelets. Exogenously added EPA was capable of inhibiting PRP aggregation induced either by exogenous or endogenous (released by ADP or collagen) arachidonate. The hypothetical combination of an EPA-rich diet and a thromboxane synthetase inhibitor might abolish production of the pro-aggregatory species, thromboxane A₂, and enhance formation of the anti-aggregatory metabolite, prostacyclin.Whereas EPA is not detectably metabolized by platelets, dihomo-γ-linolenic acid (8,11,14,-eicosatrienoic acid) is primariley converted by cyclooxygenase and thromboxane synthetase into the inactive metabolite, 12-hydroxyheptadecadienoic (HHD) acid. Pretreatment of human platelet suspensions with the thromboxane synthetase inhibitor imidazole unmasks the aggregatory property of PGH₁ and DLL which was partially compromised by the PGE₁ formed. The combination of the thromboxane synthetase inhibitor and an adenylate cyclase inhibitor unmasks a complete irreversible aggregation by DLL or PGH₁. The basis of a dietary strategy that replaces AA with DLL must rely on the production by the platelet of an inactive metabolite (HHD) rather than thromboxane A₂.     

A comparison of the inhibitory effects of melatonin and indomethacin on platelet aggregation and thromboxane release

Collagen-induced platelet aggregation and thromboxane release is inhibited, in a concentration response relationship, by preincubation of gel-filtered platelets with melatonin in the concentration range 430 nM – 4.3 mM. Inhibition of platelet aggregation and thromboxane release also occurs in the presence of indomethacin (4.3 nM – 4.3 mM), a known potent inhibitor of prostaglandin synthesis. Arachidonic acid-induced platelet aggregation and thromboxane release was inhibited in the presence of 4.0 mM melatonin. We therefore propose that inhibition of prostaglandin synthesis maybe the mechanism by which melatonin expresses its activity. Its antigonadotropic activity may result from inhibition of PGE₂ synthesis in the hypothalamus and median eminence.     

Interralation of prostaglandin endoperoxide (prostaglandin G2) and cyclic 3′,5′-adenosine monophosphate in human blood platelets

The prostaglandin endoperoxide, prostaglandin G₂, in platelet-rich plasma may produce reversible platelet aggregation without secretion, irreversible aggregation with secretion of platelet constituents inhibited by indomethacin, or the latter effects despite indomethacin, depending on the concentration of the endoperoxide. Irreversible aggregation and platelet secretion induced by prostaglandin G₂ apparently result from the action of ADP, since these responses are inhibited by 2-n-amylthio-5′-AMP (an inhibitor of the actions of ADP on platelets) and they do not occur in heparinized platelet-rich plasma. Prostaglandin G₂ lowers the platelet level of cyclic 3′,5′-AMP. Its actions are inhibited by elevation of cyclic AMP levels by prostaglandin E₁ or dibutyryl cyclic AMP or adenosine. Like malondialdehyde production induced by thrombin, ADP, or arachidonic acid, prostaglandin G₂-induced malondialdehyde production is reduced by dibutyryl cyclic AMP and prosraglandin E₁. Platelet activation by prostaglandin G₂ is enhanced by the adenylate cyclase inhibitor, 9-(tetrahydro-2-furyl)-adenine.The action of prostaglandin G₂ on platelets is more complex then previously reported.     

Sensitivity of platelets to prostaglandins in coronary heart disease and angina pectoris

The platelet sensitivity to the antiaggregatory protaglandins (PGI₂, PGE₁ and PGD₂) was studied in patients with angiographically verified coronary heart disease. The sensitivity was tested in vitro by inhibiting the APD-induced platelet aggregation by various concentrations of these prostaglandins. Beside the age dependent alterations of platelet sensitivity reported earlier, there is a statistically significant decrease in sensitivity for PGI₂ and PGE₁ in patients with coronary heart disease. In contrast, no significant change for the PGD₂-sensitivity could be observed. In angina pectoris a further significant decrease in sensitivity (again only for PGE₁ and PGI₂) was found which returned back to starting values within a few hours. In patients with maturity onset diabetes and coronary heart disease the sensitivity was always lower than in those patients with coronary heart disease alone. Changes in platelet sensitivity might play a key role in initiating and progressing atherosclerosis by an immediate disturbance of hemostatic balance. The studies further support the hypothesis that PGI₂ and PGE₁ share the same receptor on the platelet surface.     

Cyclic AMP inhibits synthesis of prostaglandin endoperoxide (PGG2) in human platelets.

Dibutyryl-cAMP but not dibutyryl-cGMP inhibited platelet aggregation and release of ¹⁴C-serotonin and ADP when induced by collagen and arachidonate but not when induced by the endoperoxide PGG₂^* (TXB₂) induced by addition of collagen to platelet rich plasma (PRP) was decreased by dibutyryl-cAMP and agents known to increase the concentration of cAMP (PGE₁, PGD₂, theophylline and acetyl choline).PGE₂ in concentrations known to decrease cAMP levels increased the formation of TXB₂ whereas concentrations of PGE₂ known to increase cAMP levels decreased the amount of TXB₂ formed. That this was due to an effect on the cyclooxygenase was indicated by inhibition of the transformation of arachidonic acid by DB-cAMP and by high concentrations of PGE₂. Additional support for regulation of the cyclo-oxygenase by cAMP and its relevance to platelet aggregation was obtained by demonstrating stimulation of PGG₂ induced aggregation by low concentrations of PGE₂ and the absence of this effect in the presence of a cyclo-oxygenase inhibitor.     

Inhibition of prostaglandin biosynthesis by SQ 28,852, A 7-oxabicyclo-[2.2.1]heptane analog

7-Oxabicyclo[2.2.1]heptane analogs of prostaglandin (PG) H₂ can act as thromboxane (Tx) A₂ receptor antagonists or agonists, PGI₂ and/rr PGD₂ receptor agonists, or exhibit a mixture of the above activities. SQ 28,852, a new analog with a hexyloxymethyl omega side chain, is a potent inhibitor of PG synthesis. SQ 28,852 inhibited collagen and arachidonic acid (AA)-induced platelet aggregation and TxB₂ and PGE₂ formation, but did not block platelet aggregation induced by ADP or the TxA₂ mimics, 9,11-azoPGH₂, SQ 26,655, and U-46,619. It also blocked conversion of AA to TxB₂, PGE₂, and 6-ketoPGF₁α by microsomal preparations of human platelets, bovine seminal vesicles, and bovine aortas, respectively, but did not inhibit the conversion of PGH₂ to TxA₂ by the platelet microsomal preparation. SQ 28,852 (p.o.) protected mice against the lethal effects of AA (75 mg/kg, i.v.). The I₅₀ values for SQ 28,852, indomethacin and aspirin were 0.025, 0.05 and 15 mg/kg, respectively. Neither SQ 28.852 nor indomethacin protected mice from death caused by 9,11-azoPGH₂. SQ 28,852 (0.01 to 1 mg/kg, i.v.) inhibited AA-induced bronchoconstriction in anesthetized guinea pigs for at least 60 min. As an inhibitor of AA-induced bronchoconstriction, SQ 28,852 was 16- and 45-times more potent than indomethacin at 3 and 60 min after i.v. administration, respectively. SQ 28,852 did not inhibit brochoconstriction induced by histamine or 9.11-azoPGH₂, indicating its specificity of action . SQ 28,852 is the first example of a new class of cyclooxygenase inhibitors whose structure is similar to that of the naturally occurring endoperoxide, PGH₂.     

Effects of prostacyclin (PGX) on cyclic AMP concentrations in human platelets

Prostacyclin (PGX) strikingly increases cyclic AMP concentrations in human platelets. Prostacyclin is approximately 10 times more active than PGD₂, 30 times more active than PGE₁ and more than 1000 times more active than its stable end product, 6-oxo-PGF_1α.These results correlate well with the anti-aggregating activity of prostacyclin, compared with PGE₁ and PGD₂.     

Prostaglandin D2 inhibits the proliferation of human malignant tumor cells

The cytotoxic effect of prostaglandin (PG) D₂, PGE₁ and PGF_2α was examined on human osteosarcoma cells (KSu cell line) , and PGD₂ was most effective. DNA, RNA and protein syntheses of KSu cells were also found to be inhibited by PGD₂ at a concentration of 5μg/ml. Furthermore, the proliferation of various human malignant tumor cells was inhibited by PGD₂ without exception so far. These results suggest that PGD₂ shows an antineoplastic effect on a variety of human malignant tumor cells.     

Cultured human skin fibroblasts and arterial cells produce a labile platelet-inhibitory prostaglandin

Human skin fibroblasts and cells cultured from human arterial smooth muscle produce a platelet-inhibitory prostaglandin in response to mechanical trauma. This prostaglandin is synthesized from an endogenous precursor rather than exogenous cyclic endoperoxides; it differs from PGE₁ and PGD₂ and resembles PGI₂ (prostacyclin) in its stability properties, being stable at pH ≥ 8.5 and labile at pH 7.4 and below. The prostaglandin synthesis pathway in these cultured cells is less sensitive to inhibition by aspirin than that in human platelets.     

Prostanoids and hemostasis in chickens: Anti-aggregating activity of the prostaglandins E1 and E2, but not of prostacyclin and prostaglandin D2

Aggregation of chicken thrombocytes was studied in whole blood using an electronic aggregometer. Serotonin (5-hydroxytryptamine, 5HT), arachidonic acid (AA) and collagen, but not adenosinediphosphate (ADP) induced aggregation. Prostaglandin (PG) endoperoxides were essential for arachidonic acid-induced aggregation, but were not involved in 5HT-induced aggregation, as indicated by inhibitory studies with indomethacin. Similar experiments indicated that biosynthesis of endogenous PG endoperoxides contributed to the aggregation induced by low concentrations of collagen, but was of little importance when high collagen doses were employed. PGE₁ and PGE₂ could abolish all types of aggregation studied, whereas prostacyclin (PGI₂) and PGD₂ were without any anti-aggregatory activity at 1 μg/ml. Between 1 and 100 ng/ml PGE₁ and PGE₂ inhibited arachidonic acid- and 5HT-induced aggregation dose-dependently.The lack of any hemostatic function of PGI₂ in chickens was also indicated by the absence of biosynthesis of endogenous PGI₂ in chicken aorta. PGI₂ was assessed as anti-aggregating activity, released by aortic fragments stirred in rabbit platelet rich plasma. Still, the presence of chicken aortic tissue i chicken whole blood inhibited 5HT-, but not arachidonic acid-induced aggregation. This inhibition was not affected by pretreatment of the aortic fragments with indomethacin or pargyline.     

Arterial walls are protected against deposition of platelet thrombi by a substance (prostaglandin X) which they make from prostaglandin endoperoxides

Prostaglandin (PG) endoperoxides (PGG₂ and PGH₂) contract arterial smooth muscle and cause platelet aggregation. Microsomes from pig aorta, pig mesenteric arteries, rabbit aorta and rat stomach fundus enzymically transform PG endoperoxides to an unstable product (PGX) which relaxes arterial strips and prevents platelet aggregation. Microsomes from rat stomach corpus, rat liver, rabbit lungs, rabbit spleen, rabbit brain, rabbit kidney medulla, ram seminal vesicles as well as particulate fractions of rat skin homogenates transform PG endoperoxides to PGE- and PGF- rather than to PGX-like activity.PGX differs from the products of enzymic transformation of prostaglandin endoperoxides so far identified, including PGE₂, F_2α, D₂, thromboxane A₂ and their metabolites.PGX is less active in contracting rat fundic strip, chick rectum, guinea pig ileum and guinea pig trachea than are PGG₂ and PGH₂. PGX does not contract the rat colon.PGX is unstable in aqueous solution and its anti-aggregating activity disappears within 0.25 min on boiling or within 10 min at 37° C.As an inhibitor of human platelet aggregation induced $\text{in vitro}$ by arachidonic acid PGX was 30 times more potent than PGE₁. The enzymic formation of PGX is inhibited by 15-hydroperoxy arachidonic acid (IC₅₀ = 0.48 μg/ml), by spontaneously oxidised arachidonic acid (IC₅₀ <100 μg/ml) and by tranylcypromine (IC₅₀ = 160 μg/ml).We conclude that a balance between formation by arterial walls of PGX which prevents platelet aggregation and release by blood platelets of prostaglandin endoperoxides which induce aggregation is of the utmost importance for the control of thrombus formation in vessels.