Theprostacyclin receptor, also termed theprostaglandin I2 receptor or justIP, is areceptor belonging to theprostaglandin (PG) group of receptors. IP binds to and mediates the biological actions ofprostacyclin (also termed prostaglandin I2, PGI2, or when used as a drug, epoprostenol). IP is encoded in humans by thePTGIRgene. While possessing many functions as defined in animal model studies, the major clinical relevancy of IP is as a powerful vasodilator: stimulators of IP are used to treat severe and even life-threatening diseases involving pathologicalvasoconstriction.
ThePTGIR gene is located on human chromosome 19 at position q13.32 (i.e. 19q13.32), contains 6 exons, and codes for aG protein coupled receptor (GPCR) of the rhodopsin-like receptor family, Subfamily A14 (seerhodopsin-like receptors#Subfamily A14).[5]
IP is most highly expressed in brain andthymus and is readily detected in most other tissues. It is found throughout the vascular network onendothelium andsmooth muscle cells.[5][6]
Standardprostanoids have the following relative efficacies asreceptor ligands in binding to and activating IP: PGI2>>PGD2=PGE2=PGF2α>TXA2. In typical binding studies, PGI2 has one-half of its maximal binding capacity and cell-stimulating actions at ~1nanomolar whereas the other prostaglandins are >50-fold to 100-fold weaker than this. However, PGI2 is very unstable, spontaneously converting to a far less active derivative6-keto-PGF1 alpha within 1 minute of its formation. This instability makes defining the exact affinity of PGI2 for IP difficult. It also makes it important to have stable synthetic analogs of PGI2 for clinical usage. The most potent of thesereceptor agonists for binding to and activating IP areiloprost, taprostene, and esuberaprost which haveKd values (i.e. concentrations which bind to half of available IP receptors) in the low nanomole/liter range.[7][8]
Several synthetic compounds bind to, but do not activate, IP and thereby inhibit its activation by the activating ligands just described. Thesereceptor antagonists include RO1138452, RO3244794, TG6-129, and BAY-73-1449, all of which have Kd values for IP at or beneath low nanomol/liter levels.[7]
IP is classified as a relaxant type of prostenoid receptor based on its ability, upon activation, to relax certain pre-contracted smooth muscle preparations and smooth muscle-containing tissues such as those of pulmonary arteries and veins.[9] When bound to PGI2 or other of its agonists, IP stimulates one or more of three types ofG protein complexes, depending on cell type:a)Gs alpha subunit-Gβγ complexes which release Gs that then stimulatesadenyl cyclase to raise intracellular levels ofcAMP and thereby activate cAMP-regulated protein kinases A-dependentcell signaling pathways (seePKA);b)Gq alpha subunit-Gβγ complexes which release Gq that then stimulates other cell signaling pathways (e.g.phospholipase C/IP3/cellCa2+ mobilization/diacylglycerol/protein kinase Cs,calmodulin-modulatedmyosin light chain kinase,RAF/MEK/Mitogen-activated protein kinases, PKC/Ca2+/Calcineurin/Nuclear factor of activated T-cells; andEGF cellular receptors; andc)Gi alpha subunit-Giβγ) complexes which releases Gi that then simulatesphospholipase C to cleave phosphatidylinositol triphosphate intoinositol triphosphate that raises intracellular CaCa2 levels thereby regulatingCalcium signaling pathways anddiacylglycerol that activates certainprotein kinase C enzymes )that phosphorylate and thereby regulate target proteins involved in cell signaling (seeProtein kinase C#Function). Studies suggest that stimulation of Gsβγ complexes is required for activation of the Gqβγ- and Giβγ-dependent pathways.[8][10][11][12] In certain cells, activation of IP also stimulatesG12/G13-Gβγ G proteins to activate theRho family of GTPases signaling proteins andGi-Gβγ G proteins to activateRaf/MEK/mitogen-activated kinase pathways.
Studies using animals genetically engineered to lack IP and examining the actions of EP4 receptor agonists in animals as well as animal and human tissues indicate that this receptor serves various functions. It has been regarded as the most successful therapeutic target among the 9 prostanoid receptors.[11]
IPgene knockout mice (i.e. IP(-/-) mice) exhibit increased tendency tothrombosis in response to experimentally-inducedEndothelium, a result which appears to reflect, at least in part, the loss of IP's anti-platelet activity.[13][14] IP activation of animal and humanplatelets inhibits theiraggregation response and as one consequence of this inhibition of platelet-dependentblood clotting. The PGI2-IP axis along with the production ofnitric oxide, acting together additively and potentially synergistically, are powerful and physiological negative regulators of platelet function and thereby blood clotting in humans. Studies suggest that the PGI2-IP axis is impaired in patients with a tendency to develop pathologicalthrombosis such as occurs in obesity, diabetes, andcoronary artery disease.[11][15]
IP activation stimulates the dilation of arteries and veins in various animal models as well as in humans. It increases the blood flow through, for example, the pulmonary, coronary, retinal andchoroid circulation. Inhaled PGI2 causes a modest fall indiastolic and small fall in systolic blood pressure in humans. This action involves IP's ability to relax vascular smooth muscle and is considered to be one of the fundamental functions of IP receptors. Furthermore, IP(-/-) mice on a high salt diet develop significantly higher levels ofhypertension, cardiac fibrosis, and cardiachypertrophy than control mice. The vasodilating and, perhaps, platelet-inhibiting effects of IP receptors likely underlie its ability suppress hypertension and protect tissues such as the heart in this model as well as the heart, brain, and gastrointestinal tract in various animal models ofischemic injury.[11] Indeed, IP agonists are used to treat patients pathologicalvasoconstriction diseases.[16] The injection of IP activators into the skin of rodents increases local capillary permeability and swelling; IP(-/-) mice fail to show this increased capillary permeability and swelling in response not only to IP activators but also in a model of carrageenan- orbradykinin-induced paw edema. IP antagonists likewise reduce experimentally-induced capillary permeability and swelling in rats. This actions is also considered a physiological function of IP receptors,[8][11] but can contribute to the toxicity of IP activators in patients by inducing, for example, life-threateningpulmonary edema.[16]
IP activators inhibit the adherence of circulating platelets and leukocytes adherence to vascular endothelium thereby blocking their entry into sites of tissue disturbance. The activators also inhibit vascular smooth muscle cells from proliferation by blocking these cells'growth cycle and triggering theirapoptosis (i.e.cell death). These actions, along with its anti-inflammatory effects, may underlie the ability of IP gene knockout in an ApoE(−/−) mouse model to cause an accelerated rate of developing atherosclerosis.[8][11]
Mouse studies indicate that the PGI2-IP axis activates cellular signaling pathways that tend to suppress allergic inflammation. The axis inhibits bone marrow-deriveddendritic cells (i.e.antigen-presenting cells that processantigen material,present it on their surfaces for delivery toT cells, and otherwise regulateinnate andadaptive immune system responses) from producing pro-inflammatory cytokines (e.g.IL-12,TNF-alpha,IL-1-alpha, andIL-6) while stimulating them to increase production of the anti-inflammatory cytokine, IL-10. IP receptor activation of these cells also blocks theirlipopolysaccharide-stimulated expression of pro-inflammatory cell surface proteins (i.e.CD86,CD40, andMHC class II molecules) that are critical for developing adaptive immune responses. IL receptor-activated bone marrow-derived dendritic cells showed a greatly reduced ability to stimulate the proliferation ofT helper cell as well as the ability of these cells to produce pro-allergic cytokines (i.e.IL-5 andIL-13)s. In a mouse model of allergic inflammation, PGI2 reduced the maturation and migration of lung mature dendritic cells toMediastinal lymph nodes while increasing the egress of immature dendritic cells away from the lung. These effects resulted in a decrease inallergen-induced responses of the cells mediating allergic reactivity,TH-2 cells. These IP-induced responses likely contribute to its apparent function in inhibiting certain mouseinflammation responses as exemplified by the failure of IP receptor deficient mice to develop full lung airway allergic responses to ovalbumin in a model of allergic inflammation.[8][6]
In human studies, PGI2 failed to alter bronchoconstriction responses to allergen but did protect against exercise-induced and ultrasonic water-induced bronchoconstriction in asthmatic patients. It also caused bronchodilation in two asthmatic patients. However, these studies were done before the availability of potent and selective IP agonists. These agonists might produce more effective inhibitor results on airways allergic diseases but their toxicity (e.g. pulmonary edema, hypotension) has tended to restrict there study in asthmatic patients.[6]
IP receptors also appear involved in suppressing non-allergic inflammatory responses. IP receptor-deficient mice exhibit a reduction in the extent and progression of inflammation in a model of collagen-induced arthritis. This effect may result from regulating the expression of arthritis-related, pro-inflammatory genes (i.e. those forIL-6,VEGF-A, andRANKL).[9][11] On the other hand, IP receptors may serve to promote non-allergic inflammatory responses: IP receptor-deficient mice exhibited increased lung inflammation in a model ofbleomycin-inducedpulmonary fibrosis while mice made to over-express the PGI2-forming enzyme,Prostacyclin synthase, in their airwayepithelial cells were protected against lung injury in this model.[6]
IP(-/-) mice exhibit little or no writhing responses in an acetic acid-induced pain model. The mouse IP receptor also appears to be involved in the development of heat-inducedhyperalgesia. These and further studies using IP receptor antagonists in rats indicate that IP receptors onpain-perceiving sensory neurons of thedorsal root ganglia as well as on certain neurons in the spinal cord transmit signals for pain, particularly pain triggered by inflammation.[8][11]
IP receptor agonists, particularly when used intravenously, have been associated with the rapid development of pulmonary edema, hypotension, bleeding due to inhibition of platelet aggregation, and tachycardia.[17][18] Clinical use of these agonists is contraindicated in patients suffering many conditions. For example, the IP agonistiloprost is contraindicated in patients with unstableangina; decompensatedcardiac failure (unless under close medical supervision); severecardiac arrhythmias; congenital or acquiredheart valve defects; increased risk of bleeding; a history ofmyocardial infarction in the past 6 months; or a history of cerebrovascular events (e.g. stroke) within 3 months.
IP receptor agonists are front-line drugs to treatpulmonary hypertension. Major drugs in this category include PGI2 itself (i.e.epoprostenol),iloprost,treprostinil, andberaprost with epoprostenol being favored in some studies.[17][19][20] However, newly developed IP agonists with favorable pharmacological features such asSelexipag have been granted by theUS FDAorphan drug status for the treatment of pulmonary hypertension. IP agonists are also to treat severe vasoconstriction inRaynaud's disease, Raynaud's disease-like syndromes, andscleroderma.[21][22] Epoprostenol causes improvements in hemodynamic parameters and oxygenation in patients suffering theacute respiratory distress syndrome but due to the limited number of randomized clinical trials and lack of studies investigating mortality, its use cannot be recommended as standard of care for this disease and should be reserved for those refractory to traditional therapies.[18] Ameta-analysis of 18 clinical trials on the use of prostanoids including principally IP receptor agonists on patients with severe lower limb peripheral artery disease due to diverse causes found that these drugs may reduce the extent of limb tissue that needed to be amputated. However, the studies did not support extensive use of prostanoids in patients with critical limb ischemia as an adjunct to revascularization or as an alternative to major amputation in cases which cannot undergo revascularization.[23]
IP receptor agonists have been used to treatThromboangiitis obliterans, a disease involving blood clotting and inflammation of the small and medium-sized arteries and veins in the hands and feet.[24]
An adenine (A) to cytosine (C)synonymous substitution at base 984 (i.e. A984C) in exon 3 ofPTGIR' is the most frequentsingle nucleotide polymorphism (SNP) variant in a sampling of Japanese. This variant was associated with an increase in platelet activation responses in vitro and an increase in incidence ofcerebral ischemia. Two other synonymous SNP variants, V53V and S328S, inPTGIR in an Italian population study were associated with enhanced platelet activation response and deep vein thrombosis.[25] The rare SNP variant 795C of 794T in thePTGIR gene is associated with an increased incidence ofAspirin-induced asthma and a greater percentage fall in theforced expiratory volume response of airways to inhalation of an aspirin like compound (lysine-acetyl salicylic acid) in a Korean population sample.[26][27]
This article incorporates text from theUnited States National Library of Medicine, which is in thepublic domain.
