Abstract

Eicosanoids and Inflammation; Prostaglandins in Clinical Practice

Abstract

Clinical strategies for the use of prostaglandins and related blocking drugs are the broad subjects of this book. A number of valuable therapeutic methods have been developed in the past decade; the future is promising for the introduction of others. The eicosanoids are ubiquitous oxygenation products of arachidonic acid that have potent vasomotor and inflammatory actions. The major clinical settings in which their modification has therapeutic importance are in obstetrics and neonatology. In obstetrical patients prostaglandin E1 has been used to promote uterine contraction and abortion, and in the neonate prostaglandin E1 will maintain patency of the ductus arteriosus, whereas cyclooxygenase inhibitors will lead to its closure. In contrast to these positive applications, the dangers of cyclooxygenase inhibitors in patients with impaired renal function are nicely summarized. Despite the abundance of experimental literature on the prostaglandins, clear clinical applications have been relatively sparse. In part this may be because of the lack of selective drugs to antagonize specific actions. There is still no thromboxane or leukotriene inhibitor available for clinical use. Because of the paucity of therapeutic devices, many of the chapters in this book leave us with only hopeful promises of research and possible future applications. The organization and quality of the chapters are not uniform. There is a multiplicity of authors, and they often cover large fields in abbreviated fashion and without critical review of the studies that are summarized. There are surprising errors of omission. For example, there is almost no mention of the neutrophil and insufficient attention to the role of eicosanoids in inflammation. The authors may be a few years early with this book, which attempts to define a clinical arena that has not yet achieved sufficient maturity from its still formative underlying science.