In 1976 Vane, Moncada, Gryglewski, and Bunting discovered that "an enzyme isolated from arteries transforms prostaglandin peroxides to an unstable substance that inhibits platelet aggregation" (58). This endothelium-derived compound, later named prostacyclin (PGI,), turned out to be the strongest inhibitor of platelet aggregation described to date. It was further characterized as a potent vasorelaxant agent in vitro (14,22) and in vivo (3). The unique pharmacological profile of prostacyclin very soon raised many hopes as to its therapeutic potential. Prostacyclin has been tested clinically in extracorporeal circulation, cardiopulmonary bypass, peripheral arterial disease, ischemic stroke, pulmonary hypertension, congestive heart failure, and coronary artery disease (91). Further clinical development of prostacyclin was hampered, however, by its chemical and metabolic instability.To overcome these shortcomings of natural prostacyclin, many attempts have been made to synthesize analogues with improved stability. Analogues with the common feature of a replacement of C1-C4 of prostacyclin by a carboxyphenylene residue and substitutions at or near C,, to achieve resistance against 15-hydroxyprostaglandin dehydrogenase have been described (25). Out of these series of analogues, [(5Z, 13E, 9a, 1 la, 15S)-2,3,4-trinor-1,5-inter-m-phenylene-6,9-epoxy-11,15-dihydroxy-15-cyclohexyl-16,17,18,19,20-pentanor]-prosta-5,13-dienoic acid, sodium salt (CG 4203; taprostene sodium-hereafter referred to as taprostene) (Fig. 1) yielded substantial prostacyclin activity as well as chemical and metabolic stability (10,25,34).
PHARMACOLOGY
Inhibition of Platelet ActivityIn hemostasis and thrombosis, activated platelets change shape, adhere to the site of the injury on a vessel wall, aggregate, and produce procoagulant activity. Inhibition of