Eicosanoids and related drugs

This slide introduces the major mediator classes and biosynthetic pathways. Release of arachidonic acid68 from membrane phospholipids by cytoplasmic phospholipase A₂ (cPLA₂) feeds cyclooxygenases 1 and 2 (Cox-1, Cox-2). These enzymes both form prostaglandin H₂, which is then converted to other prostaglandins and to thromboxanes by specific synthases downstream.

Arachidonic acid is also the substrate of various lipoxygenases (Lox) and of some cytochrome P450 enzymes (P450), which produce leukotrienes, lipoxins, and epoxytrienoic acids (EET), respectively. Endocannabinoids, which are formed from arachidonate-containing phospholipids through separate pathways, are cleaved to arachidonic acid by fatty acid amide hydrolase (FAAH). Alternatively, they may be metabolized first by Cox-2 and subsequently by one of the prostaglandin synthases, giving rise to prostamides.

The major storage lipid for arachidonic acid is phosphatidylinositol-bis-phosphate (PIP₂). In the structure of PIP₂, the arachidonyl residue is highlighted.

Synthesis of prostaglandins and leukotrienes is triggered by increased levels of cytosolic calcium, which may for example be induced by the phospholipase C pathway downstream of GPCR activation. Calcium allows cytosolic PLA₂ to bind and attack the negatively charged PIP₂. The arachidonic acid thus released is converted to precursors of prostaglandins and thromboxanes by the membrane-associated cyclooxygenases (Cox), or alternatively to leukotriene precursors by lipoxygenases (Lox). These enzymes are found on the membranes of the nucleus and of the endoplasmic reticulum.

Enzymes: 5-lipoxygenase (7), HPETE peroxidase (8), 15-lipoxygenase (9), leukotriene A4 hydrolase (10), glutathione-S-transferase (11), peptidases (12,13).

Leukotrienes are proinflammatory mediators; they play a major role in the pathogenesis of asthma. Lipoxins are important in the resolution of inflammation, that is, they are antiinflammatory.

The key feature of the cyclooxygenase active site is a tyrosine residue (Tyr385 in Cox-1; highlighted in purple) which, in order to start the reaction, must be a radical. This radical abstracts a single hydrogen from arachidonic acid, which thereby itself turns into a radical. The radical electron then migrates and combines with an O₂ π-diradical.

A cascade of further radical reactions and bond migrations lead to cyclization and to radical combination with a second O₂ molecule, which then reclaims the hydrogen from the tyrosyl residue and thus restores the enzyme to its active state. The product, prostaglandin G₂, then leaves the cyclooxygenase site to find a peroxidase site.

The peroxidase site contains heme as a prosthetic group. This heme “advances” one electron to each of the oxygen atoms in the peroxy group of the substrate, reducing their formal charges from −1 to −2 and retaining one of them. The heme itself is reduced in turn using two molecules of glutathione.

The two active sites in the cyclooxygenase molecule are close in space, and an interaction between them is required to convert the tyrosine in the cyclooxygenase site to its active radical form. In this interaction, an electron is abstracted from the reduced form of the tyrosine and consumed in the peroxidase reaction, replacing one of the electrons derived from glutathione in the regular peroxidase reaction.

In the picture, arachidonic acid is shown to indicate the location of the cyclooxygenase site; Tyr 385 is the catalytic tyrosine residue in that site. It is connected to the heme in the peroxidase site via a short stretch of three amino acid residues, which reportedly acts as the electron conduit between it and the heme.

The activation of tyrosine 385 starts with the oxidation of heme by prostaglandin G₂ or another hydroperoxide (ROOH). The oxidized heme then obtains one electron from tyrosine 385 via the conduit shown in the preceding slide, thereby activating it; another electron is presumably obtained from glutathione (not shown). Acetaminophen intercepts the activation of tyrosine 385 by reducing heme itself.

The inhibition of Cox by acetaminophen is countered by high cellular levels of hydroperoxides. Such high concentrations exist in leukocytes, which produce hydrogen peroxide and other reactive oxygen species as antimicrobial effectors (see slide 8.6). Therefore, while acetaminophen has good activity in neurons or sensory cells and therefore suppresses pain and fever, it has little effect on the synthesis of proinflammatory prostaglandins in leukocytes. Better antiinflammatory activity is observed with drugs that inhibit the enzyme in a redox-independent fashion.

Like arachidonic acid, both indomethacin and diclofenac have a carboxylic acid group, and one might reasonably surmise that all three carboxylates interact with the same amino acid residues in the active site. However, while this is true for arachidonic acid and indomethacin, crystallography shows that diclofenac sits in the active site upside down.

The carboxyl groups of arachidonic acid (left) and of indomethacin (not shown) bind to tyrosine 355 and arginine 120. In contrast, the carboxyl group of diclofenac (right) is hydrogen-bonded to serine 530 and to the catalytic tyrosine 385. Structures rendered from 1diy.pdb and 1pxx.pdb.

The above crystallographic findings agree with those from site-directed mutagenesis experiments. Arginine 120, tyrosine 255, or serine 530 were replaced with alanine or phenylalanine, respectively, whose side chains cannot engage in hydrogen bonding. An increase in the inhibitor concentration required for 50% inhibition (IC₅₀) relative to the wild type enzyme indicates that the mutant has become less susceptible to the inhibitor.

Mutants that lacked arginine 120 or tyrosine 355 were virtually resistant to indomethacin. In contrast, their inhibition by diclofenac was hardly affected by these changes, but was very sensitive to replacement of residue serine 530. Interestingly, piroxicam was susceptible to all three changes, indicating that avid binding of this inhibitor involves all three wild type residues. Data from [75].

Patients with advanced atherosclerosis are at risk of myocardial infarction or stroke, which develop when atherosclerotic lesions in the vascular endothelium trigger the formation of blood clots (see slide 10.6). Thrombocyte activation and aggregation is a key factor of blood clot formation; therefore, drugs that inhibit thrombocyte aggregation69 play an important part in the preventive treatment of such patients. An early form of such treatment was low-dose acetylsalicylic acid. The rationale for this treatment is not obvious but rather subtle.

Eicosanoids have a dual role in thrombocyte aggregation (left). The vascular endothelium inhibits aggregation through sustained secretion of PGE and PGI. Where the endothelium is damaged, exposure of collagen sets off thrombocyte adhesion and aggregation, which is amplified through the secretion of thromboxanes by the platelets themselves. Both the thrombocyte-activating thromboxanes and the inhibitory prostaglandins E and I are synthesized downstream of prostaglandin H₂. Acetylsalicylic acid inhibits the synthesis of this common precursor by cyclooxygenase; why should this result in a net inhibition of aggregation?

The answer lies in the different lifetimes of the enzyme molecules in endothelial cells and in thrombocytes, respectively (right). Endothelial cells are nucleated and can, after each dosage of the drug, replace covalently inactivated cyclooxygenase molecules with newly synthesized ones. In contrast, thrombocytes lack nuclei and protein synthesis, and therefore cannot replace the modified enzyme molecules; the effect of repeated doses will thus be cumulative. Over time, cyclooxygenase activity will therefore be diminished much more in thrombocytes than in endothelial cells.

As we have seen in slide 9.1.2, the cyclooxygenase and lipoxygenase enzymes draw from the same pool of arachidonic acid substrate. Therefore, if cyclooxygenase is inhibited, more substrate may feed into the synthesis of leukotrienes which, like several prostaglandins, have proinflammatory activity. A well-known clinical consequence of this effect is the exacerbation of bronchial asthma in patients who take acetylsalicylic acid.

The production of surplus leukotrienes illustrates that inhibition of Cox as an antiinflammatory strategy has its limitations, and that more selective strategies for controlling eicosanoid action are desirable.

Anandamide and arachidonylglycerol both contain arachidonic acid attached to a polar moiety that is biosynthetically derived from a phospholipid headgroup. Both mediators are synthesized in the postsynaptic cell in response to calcium signals; as we have seen, several neurotransmitter receptors will either directly or indirectly raise calcium levels.

The mediators are released by the postsynaptic cell into the synaptic cleft. Stimulation of presynaptic CB₁ receptors activates G proteins; the released Gβγ dimers inhibit cognate Ca⁺⁺ channels and also activate K⁺ channels, thereby reducing membrane excitability and transmitter release. The mediators are inactivated by cellular uptake and subsequent degradation by lipases (fatty acyl amide hydrolase, FAAH; monoacylglycerol lipase, MAGL; see slide 9.7.3).

This slide shows the biosynthetic pathways that produce anandamide (N-arachidonylethanolamine) and 2-arachidonylglycerol (2-AG).

Increased Ca⁺⁺ levels activate an N-acyltransferase that transfers arachidonic acid from another phospholipid molecule to the amine in the headgroup of phosphatidylethanolamine (PE). Anandamide is then released by phospholipase D (PLD). 2-AG is produced by diacylglycerol lipase (DAGL) downstream of the phospholipase C pathway.

Anandamide is hydrolyzed by fatty acid amide hydrolase (FAAH) and 2-arachidonylglycerol by monoacylglyerol lipase (MAGL). Both mediators can also be metabolized by cyclooxygenase 2 to produce prostamides, which have additional signaling roles that are not yet well characterized.

Δ⁹-tetrahydrocannabinol (THC) is the main active ingredient of cannabis and stimulates both CB₁ and CB₂ receptors. HU-308 is a CB₂-selective agonist. URB-597 inhibits fatty acyl amide hydrolase. UCM-707 is usually described as an inhibitor of cellular uptake of endocannabinoids. However, it is not clear at present that there indeed exists a specific transporter for this reuptake; this compound, too, might inhibit the hydrolase. The functional effect of both inhibitors is to amplify endocannabinoid signaling.

Rimonabant is an inverse agonist at CB₁ receptors. It has been used to reduce appetite in order to treat obesity, but was withdrawn because depression was a common side effect.