The
foreign body response (FBR) has impaired progress of new implantable
medical devices through its hallmark of chronic inflammation and foreign
body giant cell (FBGC) formation leading to fibrous encapsulation.
Macrophages are known to drive the FBR, but efforts to control macrophage
polarization remain challenging. The goal for this study was to investigate
whether prostaglandin E2 (PGE2), and specifically its receptors EP2
and/or EP4, attenuate classically activated (i.e., inflammatory) macrophages
and macrophage fusion into FBGCs in vitro. Lipopolysaccharide
(LPS)-stimulated macrophages exhibited a dose-dependent decrease in
gene expression and protein production of tumor necrosis factor alpha
(TNF-α) when treated with PGE2. This attenuation was primarily
by the EP4 receptor, as the addition of the EP2 antagonist PF 04418948
to PGE2-treated LPS-stimulated cells did not recover TNF-α production
while the EP4 antagonist ONO AE3 208 did. However, direct stimulation
of EP2 with the agonist butaprost to LPS-stimulated macrophages resulted
in a ∼60% decrease in TNF-α secretion after 4 h and corresponded
with an increase in gene expression for Cebpb and Il10, suggesting a polarization shift toward alternative
activation through EP2 alone. Further, fusion of macrophages into
FBGCs induced by interleukin-4 (IL-4) and granulocyte-macrophage colony-stimulating
factor (GM-CSF) was inhibited by PGE2 via EP2 signaling and by an
EP2 agonist, but not an EP4 agonist. The attenuation by PGE2 was confirmed
to be primarily by the EP2 receptor. Mrc1, Dcstamp, and Retlna expressions increased
upon IL-4/GM-CSF stimulation, but only Retnla expression
with the EP2 agonist returned to levels that were not different from
controls. This study identified that PGE2 attenuates classically activated
macrophages and macrophage fusion through distinct EP receptors, while
targeting EP2 is able to attenuate both. In summary, this study identified
EP2 as a potential therapeutic target for reducing the FBR to biomaterials.