Recent developments of thromboxane modulators

Therapeutic approaches in arterial thrombosis

The current standard of care for the treatment of arterial thrombosis includes anticoagulants and three classes of antiplatelet agents--aspirin, thienopyridines and glycoprotein IIb-IIIa antagonists. Although these drugs have had a significant impact on morbidity and mortality in several patient populations, up to 15% of the high risk patients with acute coronary syndrome continue to suffer from ischemic events. This problem may occur, in part, because the platelets in many patients are non-responsive to aspirin and clopidogrel. Murine models now indicate that platelets are not only responsible for arterial occlusion, they are also involved in the progression of atherosclerotic disease. New opportunities have emerged identifying potential targets and strategies for drug discovery suited to address these deficiencies by more effectively modulating platelet adhesion, thrombus growth, thrombus stability and the pro-inflammatory activity of platelets. In addition, a growing need has emerged for the development of bedside devices capable of bringing personalized medicine to patients being treated with antithrombotic drugs in order to measure the pharmacodynamic activities of new therapies, to assess the activities achieved by combined antithrombotic therapy, and to identify patients that fail to respond.

Anti-leukotriene drugs in the prevention and treatment of hepatorenal syndrome

Hepatorenal syndrome (HRS) is a peculiar form of progressive renal failure complicating the course of cirrhosis and ascites. The renal impairment of HRS is merely functional and potentially reversible. Notwithstanding, in spite of several encouraging attempts, a satisfactory medical treatment for HRS is still expected. Several pathophysiological mechanisms are active in HRS. Arachidonate metabolism derangements are among these, and prostaglandins and thromboxane antagonists have been tried with variable outcomes. Also leukotrienes (LT) appear to be involved in HRS. Three drugs (zileuton, montelukast and zafirlukast) interfering with LT synthesis and receptor binding are currently available, but they have not yet been tried in HRS. Accordingly, the author would like to suggest physicians engaged in care of these critical patients to consider a trial with these drugs-as well as with any future innovative agent active on the arachidonate-derived metabolic pathways.