Abstract-Increased levels of inflammatory cytokines contribute to the pathophysiology of pulmonary hypertension.Prostacyclin (PGI 2 ) analogues, which relax pulmonary vessels mainly through cAMP elevation, have a major therapeutic role. In this study, we show that prolonged incubation with bradykinin (BK), interleukin-1 (IL-1), and transforming growth factor- 1 (TGF- 1 ) markedly impairs cAMP accumulation in human pulmonary artery smooth muscle cells in response to short-term incubation with prostaglandin E 2 (PGE 2 ) and the PGI 2 analogues iloprost and carbaprostacyclin. A similar reduction in cAMP accumulation in response to a direct adenylyl cyclase activator, forskolin, suggested that the effect was attributable to downregulation of adenylyl cyclase. Reverse transcriptase-polymerase chain reaction studies showed downregulation of adenylyl cyclase isoforms 1, 2, and 4. The effect of IL-1, BK, and TGF- 1 on cAMP levels was abrogated by the selective COX-2 inhibitor NS398. Furthermore, it was mimicked by prolonged incubation with the COX-2 product PGE 2 and PGI 2 analogues or the COX substrate arachidonic acid, suggesting that it was mediated by endogenous prostanoids produced by COX-2. Consistent with this, IL-1, BK, and TGF- 1 all induced COX-2 and PGE 2 release. These results show that BK, IL-1, and TGF- 1 downregulate adenylyl cyclase in human pulmonary artery smooth muscle cells via COX-2 induction and prostanoid release. This suggests a novel mechanism whereby mediators and cytokines produced in pulmonary hypertension may impair the therapeutic effects of prostacyclin analogues such as iloprost and carbaprostacyclin. Key Words: interleukin-1 Ⅲ transforming growth factor- 1 Ⅲ bradykinin Ⅲ cAMP Ⅲ adenylyl cyclase P rostacyclin (PGI 2 ) analogues are effective treatment for pulmonary hypertension. 1 Long-term treatment with intravenous PGI 2 improved survival rates and reduced vascular resistance in primary and secondary pulmonary hypertension. 2 PGI 2 analogues act mainly through cAMP, a relaxant second messenger, 3 by binding to adenylyl cyclase-coupled prostacyclin receptors. 4 -6 PGI 2 analogues also regulate pulmonary artery remodeling. 7 Administration of PGI 2 analogues may compensate for defective PGI 2 production in pulmonary hypertension. Pulmonary vascular tone and remodeling is controlled by the balance between vasoconstrictor and vasodilator mediators. 8 In pulmonary hypertension, there is an imbalance with excess thromboxane A 2 and reduced dilator PGI 2 production 9 and pulmonary artery PGI 2 synthase expression. 10 Endothelin-1 (ET-1) plays an important role in pulmonary hypertension. ET-1 levels are elevated in patients with pulmonary hypertension. ET-1 has a growth regulatory effect on pulmonary smooth muscle cells, partly via K ϩ channels. 11 Inflammatory cytokines and mediators contribute to the increased pulmonary resistance and remodeling in pulmonary hypertension, 12 including interleukin-1 (IL-1), IL-6, ET-1, and prostanoids. 13,14 IL-1 is interesting because its elevate...