The effect of age on circulating 6-keto-prostaglandin F1 alpha in humans

COX-2 Inhibition by Use of Rofecoxib or High Dose Aspirin Enhances ADP-Induced Platelet Aggregation in Fresh Blood

Aim:

Increased cardiovascular risk after use of selective or nonselective cyclooxygenase-2 (COX-2)-inhibitors might partly be caused by enhanced platelet aggregability. However, an effect of COX-2 inhibition on platelets has so far not been observed in humans.

Methods:

We tested in healthy volunteers the effect of COX-2-inhibition nearly in-vivo, i.e. immediately after and even during blood sampling.

Results:

Measurement within 2 minutes after venipuncture, but not 60 minutes later, showed that 50 mg of rofecoxib (n=12) or 500 (n=8) or 1000 (n=8) mg of aspirin increased ADP-induced platelet aggregation in a whole-blood aggregometer to, respectively, 152, 176 and 204 % of basal level (p<0.01). No significant differences in aggregability were observed after ingestion of 80 mg of aspirin (n=16), or placebo (n=8). Plasma 6-keto-PGF1α was decreased to 74 % after rofecoxib and to 76 and 70 % after 500 and 1000 mg of aspirin but did not change after low dose aspirin. Continuous photometrical measurement of aggregation in blood flowing from a cannulated vein revealed that high dose aspirin did not elicit aggregation by itself, but increased ADP-induced aggregation in proportion to the decrease in prostacyclin formation (r=0.68, p = 0.004). Since in these experiments thromboxane production was virtually absent, the enhanced aggregation after partial COX-2 inhibition was not caused by unopposed thromboxane formation.

Conclusions:

We conclude that both selective and nonselective COX-2 inhibition enhances ADP-induced platelet aggregation in humans. This effect can only be detected during or immediately after venipuncture, possibly because of the short half-life of prostacyclin.

Dietary modulation of prostanoid synthesis in the aging process: role of cyclooxygenase-2

To investigate the role of cyclooxygenase (COX) as a mediator for prostaglandin synthesis in relation to generation of reactive oxidant species (ROS), we quantitated the COX-derived ROS generation and the gene expression of COX-2, an inducible form of COX in aged kidney. In addition, the modulation by dietary restriction was investigated. COX-derived ROS generation increased with age in ad libitum (AL) rats, but dietary restriction (DR) suppressed the level. The amounts of COX-2 protein and mRNA increased with age in AL rats but maintained at low levels in DR group. It was found that the binding characteristics of a nuclear transcription factor, NF-kappaB were altered by aging. The binding activity of NF-kappaB in aged kidney was significantly enhanced with the corresponding increase in mRNA and protein levels. These increases were closely in parallel to the increased ROS generation and gene expression of COX-2. The COX activity shown by NF-kappaB activation and the ROS generation by COX-mediated process were all modulated by DR. Our results suggest that the upregulation of COX-2 during aging may play an important role in many age-related diseases associated with aging process. And this upregulation was attenuated by DR. We propose that the modulation of the redox-sensitive transcription factor may well be a part of the mechanisms underpinning the anti-oxidative action of DR.

Toxicity of nonsteroidal anti-inflammatory drugs in the elderly: is advanced age a risk factor?

We reviewed the pharmacokinetic, physiologic and epidemiologic data concerning nonsteroidal anti-inflammatory drug (NSAID)-induced gastropathy and renal insufficiency in the elderly through a structured critical reading of the literature. References were collected through a search of MEDLINE and consultation with experts in the field. While there is an abundance of pharmacokinetic data comparing relevant parameters in young and old subjects, methods are not uniform and findings are inconsistent. Prostaglandin physiology appears to be altered in older versus younger subjects. Most surprisingly, there is a scarcity of epidemiologic data examining the contribution of age as a risk factor for NSAID-induced ulcers and/or renal insufficiency. The data that do exist do not clearly support age as an independent risk factor; and we believe that comorbidities, comedications and past history are more important predictors of NSAID-induced toxicity than age and more relevant in regard to therapeutic decision-making for this patient population.

Changes in urinary 6-keto-prostaglandin F1 alpha excretion during pregnancy and labor

Urinary excretion of 6-keto-PGF1 alpha was measured by high pressure liquid chromatography and radioimmunoassay at various stages of pregnancy and labor. In the first trimester of pregnancy, urinary 6-keto-PGF1 alpha concentrations were not different from those measured before pregnancy, but they showed a significant increase in the second trimester of pregnancy (p less than 0.001). The levels rose further in the third trimester, although this increase was not statistically significant when compared to levels obtained in the second trimester. There was no evidence for a significant change in 6-keto-PGF1 alpha excretion with the onset of labor. During well-established, progressive labor mean values of 6-keto-PGF1 alpha excretion were about twice as high as before the onset of labor, but the range of values during labor was so wide that there was no statistical difference with values obtained in the second half of pregnancy. It is concluded that the increase in the urinary excretion of 6-keto-PGF1 alpha occurs later in pregnancy than the increase in TXB2 excretion and that labor at term is not associated with marked changes in 6-keto-PGF1 alpha excretion.

The effect of age and smoking on vascular prostaglandin production in men and women

6-Keto-PGF1 alpha, PGF2 alpha and PGE2 production by homogenates of aorta was unaffected by age, sex or smoking habits. Homogenates of saphenous vein from women aged 51-60 years produced greater and smaller amounts of 6-keto- PGF1 alpha and PGF2 alpha, respectively, than from women aged 41-50 and 61-70 years. In the 41-50 and 61-70 age groups, the amounts of 6-keto-PGF1 alpha and PGF2 alpha produced by homogenates of saphenous vein were smaller and greater, respectively, in women than in men. Cigarette smoking had no effect on PG production by homogenates of female saphenous vein. 6-Keto-PGF1 alpha production by homogenates of male saphenous vein was 20% lower in smokers and ex-smokers than in non-smokers, although this reduction was statistically significant only for ex-smokers. The amounts of PGE2 and PGF2 alpha produced by homogenates of male saphenous vein were smaller in smokers and ex-smokers, respectively, than in non-smokers. In spite of these changes in PG production by homogenates of saphenous vein, the basal outputs of PGs, particularly of 6-keto-PGF1 alpha, from the saphenous vein were little affected by age, sex or smoking habits.

Synthesis of prostaglandin E by peritoneal macrophages from NZB/W mice

Peritoneal macrophages from NZB/W (murine lupus) mice spontaneously produce less prostaglandin E (PGE) than peritoneal macrophages from immunologically normal mice. Reduced PGE synthesis is seen as early as 2 months of age and becomes more profound as disease progresses. It is suggested that impaired production of PGE by peritoneal macrophages from NZB/W mice may account in part for abnormal macrophage function observed in these animals.

Plasma 6-keto-PGF1 alpha, thromboxane B2 and PGE2 in type 1 (insulin-dependent) diabetic patients during exercise

The capacity of prostacyclin production determined as plasma 6-keto-PGF1 alpha was investigated in 12 type 1 (insulin-dependent) diabetic patients with a median duration of diabetes of 14 years during ordinary metabolic control. Using high pressure liquid chromatography preceding radioimmunoassay, the plasma concentration of 6-keto-PGF1 alpha, the stable metabolite of prostacyclin, was determined at rest and after a standardised bicycle exercise test. The plasma 6-keto-PGF1 alpha in diabetic patients at rest did not differ from that of 25 healthy volunteers; 2.9 pg/ml (range less than 0.2-15.3) versus 1.7 pg/ml (range less than 0.2-16.6). During the exercise test plasma 6-keto-PGF1 alpha increased significantly in the diabetic patients as well as in the control group (p less than 0.05). The increment of 6-keto-PGF1 alpha in the diabetic patients was neither related to the metabolic regulation, duration of diabetes nor to changes in platelet volume, platelet number or the production of thromboxane B2 and prostaglandin E2. Our results do not support the hypothesis that Type 1 diabetic patients have a decreased capacity of prostanoid production, as suggested from in vitro studies.

Effect of age on vascular prostaglandin production in male and female rats

The incidence of vascular disorders increases with age, and is also higher in men than in women. Since prostaglandin (PG)I2 produced by blood vessels has been proposed to have a protective function in the cardiovascular system, reduced vascular PGI2 production with age and lower vascular PGI2 production in males than in females may be causes for these increases in the incidence of vascular disorders. The production of prostaglandins by blood vessels has therefore been investigated in young (2 to 3 months) and old (12 to 14 months), male and female rats. The amounts of 6-keto-PGF1 alpha (reflecting PGI2 formation) synthesized by endothelial cell suspensions were significantly lower in old compared to young male rats, but did not differ between old and young female rats. The amounts of 6-keto-PGF1 alpha synthesized by homogenates of aortic smooth muscle were considerably higher in old compared to young, male and female rats. However, the basal output of 6-keto-PGF1 alpha from the perfused aorta in vitro did not change significantly with increase in age and, if anything, tended to be higher in the older rats, of both sexes. Furthermore, the basal output of 6-keto-PGF1 alpha from the aorta was significantly higher in young and old, male rats compared to young and old, female rats, respectively. Similar findings were observed regarding basal 6-keto-PGF1 alpha output from the perfused mesenteric arterial bed in vitro. The increases in output of 6-keto-PGF1 alpha from the mesenteric arterial bed in response to noradrenaline and angiotensin II were not diminished with age in either male or female rats. Consequently, PGI2 output from the blood vessels studied did not decrease with age, nor was it lower in male rats compared to female rats. The blood pressure was significantly higher in the old rats compared to the young rats. Also, the vascular output of PGF2 alpha, a vasoconstrictor, was higher in the old rats. The increase in blood pressure with age may therefore be connected with this increase in vascular PGF2 alpha production in both sexes.

Plasma prostaglandins: 6-keto-PGF1 alpha, TXB2 and PGE2 in juvenile-onset diabetes determined by high-pressure liquid chromatography and radio-immunoassay

Some studies have recently reported increased production of platelet thromboxane and decreased vascular prostacyclin in patients with diabetes mellitus. The impact of these changes on platelet and vascular functions in vivo is still speculative. Using radio-immunoassay and high pressure liquid chromatography we have studied the plasma levels of 6-keto-PGF1 alpha, TXB2 and PGE2 in 23 juvenile-onset diabetics. There was no significant difference in these plasma prostaglandins between the diabetics and a control group. The prostaglandins were neither correlated to blood-glucose nor the degree of glycosylation (HbA1c). Our results can not support the hypothesis that decreased vascular prostacyclin and increased platelet production of TXB2 are important factors in diabetic patients.

Gender differences in prostacyclin and prostaglandin E2 synthesis by human endothelial cells

The incidence of atherosclerosis and thrombosis is higher in males than in females. Gender differences in prostacyclin synthesis by rat aortic rings have been described. In this paper, sex differences in prostacyclin (PGI2, measured as 6-keto PGF1 alpha) and prostaglandin E2 (PGE2) synthesis by human endothelial cells isolated from the vein of umbilical cords are reported. Cells isolated from cords from male babies synthesized more prostacyclin and PGE2 than cells isolated from those from female babies when the cells were stimulated with 0.125 units of thrombin. The difference in PGI2 was eliminated by incubation with 0.5 units of thrombin. PGE2 synthesis was higher in males than in females using both 0.125 and 0.5 units of thrombin. Incubation of the cells with culture medium containing 20% heat inactivated plasma from either male or female subjects did not have an effect upon prostaglandin synthesis. Our results support previous evidence obtained using rat aortas and show a higher response of male cells to thrombin stimulation than that of female cells.

Eicosenoid biosynthesis and platelet function with advancing age

The pathogenesis of atherosclerosis, a major cause of age-related mortality, remains poorly understood. Although platelets and their products, including thromboxane A2, may be of importance in this process, little is known about eicosenoid biosynthesis and platelet function with increasing age. In order to address the hypothesis that platelet activation increases with age, we measured various indices of platelet function in a group of apparently healthy individuals over the age of 50 years. The circulating platelet aggregate ratio, plasma beta-thromboglobulin and threshold aggregating concentration of arachidonic acid were similar to those in healthy subjects aged less than 40 years. Although the bleeding time (168 +/- 24 vs 300 +/- 24 seconds) was significantly (p less than 0.001) shorter in the older volunteers this may be unrelated to platelet function and merely reflect age related changes in skin and/or vascular function. To further assess platelet and vascular function in vivo, we measured excretion of the major thromboxane and prostacyclin metabolites in urine, 2,3-donor-thromboxane B2 (Tx-M) and 2,3-dinor-6-keto-PGF1 alpha (PGI-M). Both Tx-M (223 +/- 22 vs 152 +/- 19 pg/mg creatinine; p less than 0.005) and PGI-M (198 +/- 21 vs 121 +/- 13 pg/mg creatinine; p less than 0.005) excretion were significantly higher in the older volunteers. These subtle but significant changes in eicosenoid biosynthesis are consistent with the presence of platelet activation in vivo increasing with age in apparently healthy individuals.

Age-associated changes in rat plasma lipids, platelet fatty acids and prostacyclin release

The effect of age on plasma lipids, platelet fatty acids and prostacyclin release was studied in the rat. The contents of arachidonic acid, cholesterol, bile acids and free fatty acids in the plasma of aged rats (15 months old) were higher than those of young rats (3 months old). No significant differences in fatty acid composition of platelet lipids and release of prostacyclin from aortas between young and aged rats were observed. The data suggest that plasma lipids may play a more important role in the development of cardiovascular disease with increasing age than prostaglandins do.

Age-, cycle- and topographic dependency of human myometrial prostaglandin (6-keto-PGF1 alpha, PGF2 alpha)-synthesis in vitro

Specimens of human myometrium (isthmus and fundus) freshly obtained at hysterectomy were immediately transferred in ice cold Tyrode solution and placed in superfusion chambers. Spontaneous contractions were recorded, the effluent of the myometrium was analyzed for PGF2 alpha and 6-keto-PGF1 alpha by use of specific radioimmunoassay systems. Dating of the menstrual cycle was achieved by histological evaluation of the endometrium. The PG release rates expressed as ng/min/g wet weight were correlated to the patients age and to the phase of the menstrual cycle. The production rates of 6-keto-PGF1 alpha were negatively correlated to the age of the patients and declined in fundus specimens from 2.89 +/- 0.35 ng/min/g wet weight in 39-42 years old patients to 0.52 +/- 0.17 ng/min/g wet weight in 48-52 years old women during the secretory phase (p less than 0.001). Similar significant correlations were found in specimens obtained from the isthmus uteri. During the proliferative phase fundus specimens produced on average 1.61 +/- 0.67 ng/min/g wet weight in 39-42 years old patients and 0.49 +/- 0.12 ng/min/g wet weight 6-keto-PGF1 alpha in 48-52 years old women respectively (p les than 0.001). The PGF2 alpha synthesis in myometrial specimens of fundus or isthmus origin was significantly lower than 6-keto-PGF1 alpha and did not correlate to the age of the patients during the proliferative phase. However, PGF2 alpha release rates during the secretory phase were significantly (p less than 0.001) higher in younger women. These results suggest an age-, cycle- and topographic dependency of PGI2 synthesis in human myometrial tissue.