Mechanisms for the stimulation of prostanoid synthesis by cyclosporine and bacterial lipopolysaccharide

Evidence that cyclosporine inhibits periodontal prostaglandin I2 synthesis

Cyclosporine (CsA) is a selective immunosuppressant widely used in clinical therapy. Like phenytoin and nifedipine, the drug is associated with gingival overgrowth. This study considers the interaction of CsA and prostaglandin I2 (PGI2), in particular the action of the drug on gingival tissue in vitro and in vivo. The PGI2-synthesis of rat, rabbit and human gingival tissue was examined by bioassay. In vivo CsA-therapy reduces gingival PGI2-synthesis. The results furthermore show a dose-dependent inhibition of PGI2-synthesis by CsA (1-100 micrograms/ml) in vitro. PGI2-synthesis from in vivo CsA-pretreated probes was further dose-dependently diminished by in vitro addition of CsA. As PGI2 exerts an antiproliferative activity via cAMP-elevation, the drug-induced inhibition of PGI2 production is claimed to be responsible for gingival hyperplasia in CsA-treated patients.

Role of the renin-angiotensin system on the renal functional reserve in renal transplant recipients

To determine the renal functional reserve in renal transplant recipients, we measured the glomerular filtration rate by inulin clearance and the renal plasma flow by PAH clearance before and during an amino acid infusion (Totamine, 6 to 8 mg/kg/min for 90 to 120 min) in 18 transplanted patients with stable renal function. To test the role of the renin-angiotensin system on the renal functional reserve, we performed a crossover placebo-controlled randomized trial of acute blockade of the renin-angiotensin system by injection of perindoprilat (2 mg i.v.), an inhibitor of angiotensin converting enzyme before amino acid infusion, each patient being studied twice at seven day intervals. Amino acid infusion induced a time-dependent increase in the glomerular filtration rate (P = 0.04), whether or not the renin-angiotensin system was blocked. Maximal increases were from 49.1 +/- 4.1 to 58.9 +/- 5.4, mean +/- SE (18.5%), in control conditions and from 52.4 +/- 5.6 to 62.1 +/- 5.5 ml/min/1.73 m2 (19.7%) after perindoprilat. The increase in glomerular filtration rate was less pronounced in patients taking cyclosporin A than in patients treated with steroid and azathioprine. Amino acid infusion also induced a significant and time-dependent increase (15.2 to 20.2%) in the renal plasma flow (P < 0.01) whether or not perindoprilat had been given. Furthermore, perindoprilat alone increased renal plasma flow by 13.6%, and this effect seemed additive with that of amino acids. Perindoprilat injection decreased filtration fraction (from 0.20 +/- 0.01 to 0.19 +/- 0.01). This parameter returned to basal values after amino acid infusion (0.20 +/- 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Interactions between the monocyte/macrophage and the vascular smooth muscle cell. Stimulation of mitogenesis by a soluble factor and of prostanoid synthesis by cell-cell contact

The effect of soluble factors from the monocyte/macrophage (M phi) on cell proliferation and the functional effects of cell-cell contact on the arachidonic acid (AA) cascade were studied with vascular smooth muscle cells (SMCs). Peripheral blood M phi s were isolated by adherence or in a Percoll gradient, and alveolar M phi s were obtained by lavage. Conditioned medium (CM) was prepared by preincubating M phi s with medium alone or by separating SMC and M phi cocultures by a membrane insert. Cell proliferation (image analysis) and 6-ketoprostaglandin F1 alpha (6-keto-PGF1 alpha, radioimmunoassay) were measured in SMCs. Labeled prostanoids and other eicosanoid metabolites were isolated by high-performance liquid chromatography from SMCs prelabeled with 14C-AA. M phi s did not synthesize 6-keto-PGF1 alpha. The CM enhanced proliferation but did not stimulate 6-keto-PGF1 alpha synthesis in SMCs. However, cell-cell contact in cocultures of SMCs with the same concentration of M phi s used to generate CM resulted in increased 6-keto-PGF1 alpha synthesis by SMCs. Since the stimulatory effect of cell contact was not blocked by butylated hydroxytoluene, it could not be attributed to an oxidative burst from M phi s. Functional studies showed that the stimulatory effect of cell contact was enhanced by exogenous free AA and by endogenous AA release through A23187. Release of total radioactivity from prelabeled SMCs was enhanced by cell contact, and this effect was blocked by indomethacin (IM). Cell contact did not increase the release of free AA from prelabeled SMCs, even in the presence of IM. Finally, cell contact only stimulated the formation of prostanoids (IM-sensitive eicosanoid metabolites) from prelabeled SMCs. Lipoxygenase and other products of AA were not formed through cell-cell contact. These data showed that M phi s express a soluble factor that enhances SMC proliferation without affecting prostanoid synthesis. Subsequent cell contact between SMCs and M phi s stimulates prostanoid synthesis, which may possibly serve as a local and focal homeostatic mechanism for the regulation of uncontrolled SMC proliferation in atherogenesis.

Action of bradykinin at the cyclooxygenase step in prostanoid synthesis through the arachidonic acid cascade

Bradykinin enhances prostanoid synthesis in aorta smooth muscle cells. Free arachidonic acid also enhances prostanoid synthesis and bradykinin, unlike fatty acid releasing agents, has a synergistic effect with free arachidonic acid. Bradykinin promotes metabolite release from cells prelabeled with [14C]-arachidonic acid and this effect is blocked completely by indomethacin. High performance liquid chromatography shows increase amounts of labeled 6-keto-prostaglandin F1 alpha, prostaglandin E2 and three additional cyclooxygenase-dependent metabolites but no increase in free arachidonic acid or other metabolites either in the absence or presence of indomethacin. Fatty acid releasing agents such as A23187 and cyclosporine A have very different effects on cells. These agents enhance levels of prostanoids, a number of other cyclooxygenase-independent metabolites, and free arachidonic acid which is even more elevated with added indomethacin. Bradykinin behaves in all respects like another agent, bacterial lipopolysaccharide, and the action of both agents is consistent with a mechanism involving cyclooxygenase rather than fatty release in the arachidonic acid cascade.

The pathophysiology of Sandimmune (cyclosporine) in man and animals

Part I: The side-effects of Sandimmune that have been of most significance clinically are renal dysfunction, renal vascular damage and arterial hypertension. To examine the nature and the origin of such effects, the actions of Sandimmune on the renal tubule, the renal vessels and systemic vessels have been analyzed. To evaluate whether common vasoconstrictory systems may be involved, changes in the renin-angiotensin-aldosterone system and prostaglandin-thromboxane system have been assessed. Comparison between animal and human data obtained in vivo and in vitro shows the actions of Sandimmune on the renal tubule to be modest and involve only a few specific effects. The major action of Sandimmune is on the vessels, vasoconstriction being the major cause of renal dysfunction and also the cause of arterial hypertension. Neither the circulating renin-angiotension-aldosterone system nor the prostaglandin-thromboxane system is clearly responsible for vasoconstriction. Although not itself a vasoconstrictor, Sandimmune seems to modulate the constrictory and dilatory response to other agents in several vascular beds.

A new perspective on canine keratoconjunctivitis sicca. Treatment with ophthalmic cyclosporine

Keratoconjunctivitis sicca is the major cause of chronic or recurrent conjunctivitis in dogs. The diagnosis of KCS is often delayed or mistaken for allergic or bacterial conjunctivitis and inappropriate or insufficient treatment leads to progressive corneal scarring and blindness in many dogs. The cause of KCS in dogs has not been proven, but evidence supports an immune-mediated etiology for the majority of cases. In an attempt to specifically treat the cause of KCS, a new immunosuppressant drug, cyclosporine, has been used in a topical preparation. Treatment results using ophthalmic cyclosporine are dramatic compared with historical treatments. Resolution of corneal scarring and increased lacrimation are seen in most dogs. Investigations of the mechanism of action of ophthalmic cyclosporine suggest the efficacy may have been serendipitous. A local neuroendocrine effect of cyclosporine on the lacrimal gland may actually be responsible for the increased lacrimation. Early diagnosis of KCS and treatment with ophthalmic cyclosporine may avert a major cause of blindness in dogs.