Cyclooxygenase, prostaglandin metabolism

The major classical drug target in prostaglandin metabolism is cyclooxygenase, which occurs in several isoforms Cox-1, Cox-2, and apparently in some mammals Cox-3. This is due to the central role of its product prostaglandin H2 as a precursor of multiple eicosanoid mediators (Figure 12.4). 

Fig. 1 Cyclooxygenase-initiated metabolization of arachidonic acid (AA) to prostaglandins (PCs) and thromboxanes (TXs).

Palytoxin is hemolytic (4) and is an extremely potent toxin (7). We have shown that in rat liver cells palytoxin stimulates de-esterification of cellular lipids to liberate arachidonic acid (5). These rat liver cells metabolize this increased arachidonic acid via the cyclooxygenase pathway to produce prostaglandin (PG) I2 and lesser amounts of PGE2 and PGp2. Palytoxin acts on many cells in culture to stimulate the production of cyclooxygenase metabolites (Table I). Clearly, the myriad pharmacological effects of the arachidonic acid metabolites must be considered in any explanation of the many clinical manifestations of palytoxin s toxicity. 

Cyclooxygenase Enzymes responsible for metabolizing arachidonic acid to prostaglandins. 

Prostaglandin Any of a large group of biologically active, carbon-20, unsaturated fatty acids that are produced by the metabolism of arachidonic acid through the cyclooxygenase pathway. 

SMP-114 (licofelone) is a drug candidate for rheumatoid arthritis, currently in Phase II clinical trials (Figure 8.57). It inhibits all three of the major enzymes involved in the arachidonic acid pathway (5-LOX, COX-1, and COX-2), thereby preventing production of both leukotrienes and prostaglandins. This mode of action could therefore lead to a better tolerability than that of conventional cyclooxygenase (COX-1 and COX-2) inhibitors because of the shunt of arachidonic acid metabolism toward the production of proinflammatory leukotrienes, via 5-lipoxygenase (LOX). 

Common NSAIDs include aspirin, ibuprofen, indomethacin, naproxen, and ketoprofen. Even though anti-inflammatories generally target cyclooxygenase, there are apparent differences in the details of how they relieve pain. For example, aspirin acts by primarily inhibiting the COX-dependent synthesis of eicosanoids, which are end products of metabolism of essential fatty acids including prostaglandin... 

In susceptibie individuais, NSAIDs may precipitate acute bronchospasm. It affects 10-20% of adults with asthma but is rare in asthmatic children. The mechanism is related to cyclooxygenase inhibition, with shunting of arachidonic acid metabolism from the prostaglandin pathway to the biosynthesis of ieukotrienes with increased mucosal permeability and bronchospasm. Susceptible patients should avoid NSAIDs since the bronchospasm may be severe and has been fatal. Paracetamol in doses up to 1000 mg daiiy wiii be toierated by most patients. True type I allergic reactions to NSAIDs, with specific IgE, are rare but anaphyloactoid reactions have occasionally been described in patients with a history of aiiergy or bronchiai asthma. 

The cell damage associated with inflammation acts on cell membranes to cause leukocytes to release lysosomal enzymes arachidonic acid is then liberated from precursor compounds, and various eicosanoids are synthesized. As discussed in Chapter 18, the cyclooxygenase (COX) pathway of arachidonate metabolism produces prostaglandins, which have a variety of effects on blood vessels, on nerve endings, and on cells involved in inflammation. The lipoxygenase pathway of arachidonate metabolism yields leukotrienes, which have a powerful chemotactic effect on eosinophils, neutrophils, and macrophages and promote bronchoconstriction and alterations in vascular permeability. 

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