Objective-Low concentrations of prostaglandin (PG) E 2 enhance platelet aggregation, whereas high concentrations inhibit it. The effects of PGE 2 are mediated through 4 G protein-coupled receptors, termed E-type prostaglindin (EP) receptor EP1, EP2, EP3, and EP4. The platelet-stimulating effect of PGE 2 has been suggested to involve EP3 receptors. Here we analyzed the receptor usage relating to the inhibitory effect of PGE 2 . Methods and Results-Using flow cytometry, we found that human platelets expressed EP4 receptor protein. A selective EP4 agonist (ONO AE1-329) potently inhibited the platelet aggregation as induced by ADP or collagen. This effect could be completely reversed by an EP4 antagonist, but not by PGI 2 , PGD 2 , and thromboxane receptor antagonists or cyclooxygenase inhibition. Moreover, an EP4 antagonist enhanced the PGE 2 -induced stimulation of platelet aggregation, indicating a physiological antiaggregatory activity of EP4 receptors. The inhibitory effect of the EP4 agonist was accompanied by attenuated Ca 2ϩ flux, inhibition of glycoprotein IIb/IIIa, and downregulation of P-selectin. Most importantly, adhesion of platelets to fibrinogen under flow and in vitro thrombus formation were effectively prevented by the EP4 agonist. In this respect, the EP4 agonist synergized with acetylsalicylic acid. Key Words: aspirin Ⅲ pharmacology Ⅲ platelet receptor blockers Ⅲ platelets Ⅲ prostacyclin Ⅲ prostaglandins Ⅲ thromboxanes S ubjects with increased platelet reactivity are at increased prospective risk for coronary events and death. A number of pathophysiological states, such as atherosclerosis, diabetes, and metabolic syndrome, are associated with increased platelet reactivity and thrombogenic potential. Under inflammatory conditions, the synthesis of prostanoids in endothelial cells and smooth muscle cells is highly increased. Predominantly, the biosynthesis of prostaglandin (PG) E 2 is enhanced in vascular smooth muscle cells 1 and macrophages 2,3 by inflammatory mediators.
Conclusion-TheseProstanoids are involved in hemostasis by differentially influencing platelet aggregation. Although thromboxane (TX) A 2 , produced in platelets, and PGH 2 , released untransformed from activated/dysfunctional endothelium, are potent stimulators of platelet aggregation, 4 PGI 2 and PGD 2 are known to inhibit platelet aggregation. 5 PGE 2 shows a biphasic, concentration-dependent effect on platelet aggregation. Although high concentrations inhibit platelet aggregation, lower concentrations enhance it. 6 -11 PGE 2 binds and activates 4 G protein-coupled receptors, EP1, EP2, EP3, and EP4. Each of these receptors has a distinct pharmacological signature and intracellular signal transduction. 12,13,14 Stimulation of the EP3 receptors results in elevation of free intracellular Ca 2ϩ levels, whereas stimulation of the EP2 and EP4 receptors usually increases intracellular cAMP levels through activation of G s protein, 12 resulting in a decrease of intracellular Ca 2ϩ levels. Human platelets contain mRNA for EP1 receptors,...