Cyclooxygenase and 5-lipoxygenase pathways in the vessel wall: role in atherosclerosis

Prostaglandins (PGs), thromboxanes (Txs), and leukotrienes (LTs) play a relevant role in cardiovascular physiology and pathophysiology. Recent reports concerning cardiovascular risk associated with cyclooxygenase-2 selective inhibitors have prompted questions about the "protective" or "deleterious" role of each COX isoform in cardiovascular disease, and the cloning and expression of inducible PGE-synthase (PGES) open the possibility that PGES could be a new therapeutical target in this context. Predominance of constricting or relaxing prostanoids depends not only on COX activity but also to downstream enzymes such as PGI-synthase (PGIS) and PGES. In the vessel wall, PGIS and PGES seem to be major downstream enzymes in the endothelium and smooth muscle, respectively. Like COX, activity of these enzymes can also be regulated by several factors, which include nitrogen oxides, cytokines, and lipid peroxides. LTs are important inflammatory mediators also involved in the pathophysiology of cardiovascular disease, which are targets for pharmacological intervention. Unlike COX pathway, the biosynthesis of chemotactic and vaso-constrictor LTs in the vasculature strongly depends on leukocyte recruitment and activation, and on cell-cell interaction between leukocytes and vascular cells in the inflamed areas. The present review emphasizes the role of vascular-derived prostanoids and LTs on atherosclerosis.