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    • Among prostaglandins PG PGD remained

    2021-01-19

    Among prostaglandins (PG), PGD2 remained the most elusive species for a long time and was initially regarded as having negligible biological activity [1]. In 1974 its inhibitory effect on platelet aggregation was discovered by Smith et al. [2] and Mills & McFarlain [3], and both pressor and depressor actions were found in different smooth muscle preparations by Horton et al. [4]. In 1976, pro-inflammatory actions of PGD2 were described by Flower et al. in rat and human skin, causing erythema and edema, however, in the absence of pain [5]. In dog lung, PGD2 was observed to cause broncho- and vasoconstriction, while causing systemic hypotension [6] and renal vasodilation [7]. In contrast, guinea pig coronary calcitonin receptor were constricted by PGD2 [8], [9]. Later it was shown that it was the thromboxane receptor, TP, that mediated these constrictor effects, as PGD2 was found also to bind to TP at micromolar concentrations [10], whereas inhibition of platelet aggregation and vasodilation by PGD2 depended on its cognate D-type prostaglandin receptor, DP (also named DP1) [11]. In 1978, Anhut et al. [12] suggested that PGD2 was formed during anaphylactic reactions, which might contribute to broncho- and vasoconstriction during asthma attacks, as they hypothesized. Four years later, Lewis et al. demonstrated that mast cells were a major source of PGD2 [13]. Although Peskar & Brune already proposed in 1979 that PGD2 was the prevailing PG in acute inflammatory responses [14], its immune modulator mode of action still needed to be elucidated. In dogs, two studies indirectly suggested that PGD2 might be a chemoattractant for eosinophils, the first showing that intravenous PGD2 caused a transient drop in circulating eosinophil numbers [15], and the second that intratracheal PGD2 caused intra-luminal eosinophil accumulation [16]. In 1990, Woodward et al. described the ocular hypotensive effect of PGD2 and the selective DP1 agonist BW245c in guinea pigs [17]. However, they also found that PGD2–but not the DP1 agonist − induced ocular inflammation characterized by accumulation of eosinophils in the conjunctiva. Interestingly, the PGD2 metabolite PGJ2 was as effective as PGD2 in causing eosinophil accumulation, but was unable to decrease ocular pressure, which pointed to a yet unknown PGD2 receptor. Subsequently, PGD2 was shown to stimulate the migration of eosinophils towards zymosan-activated serum and induce calcium flux in human eosinophils [18], [19], but it was only in 2001 that PGD2 was unequivocally shown to be a potent eosinophil chemoattractant acting through a novel receptor termed chemoattractant receptor homologue expressed on Th2 cells (CRTH2; alternative name: DP2) [20], [21], [22]. This receptor had previously been cloned as an orphan receptor (GPR44) that was expressed by eosinophils, basophils and Th2 lymphocytes [23]. In fact, CRTH2 was characterized as the most reliable surface marker for Th2 cells [24]. With these findings in mind, PGD2 and its receptor CRTH2 has become one of the most promising therapeutic targets in the field of allergy and asthma, which was also fueled by the discovery of indomethacin as a potent and selective CRTH2 agonist. This clinically used cyclooxygenase inhibitor subsequently served as a pharmacophore for the development of several CRTH2 antagonists [25], belonging to the family of indole-acetic acid derivatives. Some of those including OC000459, or AZD1981 have already been evaluated in clinical studies for the treatment of asthma, allergic rhinitis and eosinophilic esophagitis [26], [27], [28], [29], [30]. Although, major breakthroughs in the clinical usefulness of CRTH2 antagonists are still to be anticipated, recent studies in allergic asthma are showing promising results: Fevipriprant improved lung function in a subgroup of patients suffering from severe air flow limitation [31] and timapriprant (OC000459) beneficially altered asthma control as well as lung function in atopic eosinophilic asthmatics [32]. Timapiprant and another CRTH2 antagonist, BI 671800, also successfully reduced nasal and ocular symptoms in allergic subjects exposed to grass pollen [27], [33]. For a detailed review of PGD2 receptor antagonists in the treatment of asthma, please refer to the recent review by Santus and Radovanovic [25].