Treatment of ischaemic stroke with prostacyclin

Eicosanoids in the central nervous system

All mammalian tissue investigated to date is capable of eicosanoid biosynthesis in response to various activating stimuli. While the importance of these metabolites as major mediators of many normal physiological processes and some pathophysiological conditions has not been proven, it is evident that these compounds are at least important modulators of many cellular and organ system functions. This review is intended to provide the reader with a brief overview of eicosanoid biology, with specific reference to the neurosciences. The increasing knowledge about the role of the eicosanoids in neurobiology may contribute to the understanding and treatment of many neurological diseases. The eicosanoids comprise several groups of biologically active unsaturated fatty acids: the "primary" prostaglandins, the cyclic endoperoxides, the prostanoids, the leukotrienes, and other acid lipids. This article includes a review of the enzymatic pathways of biosynthesis and metabolism of eicosanoids in man, and the pertinent structural nomenclature. The general basic and clinical pharmacological effects of the more important compounds on vascular perfusion, platelet function, intracellular enzyme activity, and interactions with other mediators of cellular activity are reviewed. A more detailed review of the actions of eicosanoids as mediators or modifiers of central nervous system physiology and pathophysiology is presented. Recent animal and human studies on the use and alterations of the eicosanoid metabolites is summarized, specifically where they relate to several clinical problem areas of interest to the neurosurgeon and neurobiologist. These areas include cerebrovascular circulation physiology, cerebral ischemia, cerebral vasospasm following subarachnoid hemorrhage, migraine headaches, hypothalamic function, neurotransmission, and nociception. A bibliography of 92 articles for further review is also included.

Influence of prostacyclin on early morphological changes in the rabbit brain after complete 20-min ischemia

Complete 20-min lasting cerebral ischemia was induced in 12 rabbits. They received PGI2 3 min before, during, and for 15 min after ischemia. Control animals with complete cerebral ischemia over the same period of time were not given PGI2 medication. The ECoG changes of the animals receiving PGI2 recovered twice as fast as those of the controls. PGI2 had no noticeable effect on the loosening of the CNS white matter after ischemia; however, the perivascular swelling was much less conspicuous. PGI2 reduced the spectrum of neuronal changes and decreased the number of pathologically changed neurons in the cerebral hemispheres. Sporadically, the Purkinje cells underwent homogenisation without shrinkage of cytoplasm. The bulbar motoneurons were morphologically normal in all animals treated with PGI2. The results indicate a cytoprotective action of PGI2 on cerebral neurons during ischemia, and/or the prevention of CBF disturbances by this compound.

Prostacyclin for ischemic ulcers in peripheral arterial disease. A random assignment, placebo controlled study

A 72 h infusion of prostacyclin or placebo was given into femoral artery as a treatment for ischemic ulcers in 30 patients with peripheral arterial disease. Patients were well matched for age, sex, type and localization of disease, rest pain, number and area of ulcers, calf blood flow and previous sympathectomies. They had no diabetes mellitus, gangrene or marked aorto-iliac involvement. Six weeks after the infusion there was a significant difference in ulcer area between the two groups (p less than 0.02, t unpaired test): mean ulcer area decreased (p less than 0.02, t paired test) in the prostacyclin-treated group, but not in the placebo group (p greater than 0.05, t paired test). Thus, intra-arterial infusion of prostacyclin promotes healing of ischemic ulcers in non-diabetic patients with peripheral arterial disease without gangrene.