The physiologic role of the
prostaglandins is complex and not yet defined precisely. Nevertheless, these ubiquitous compounds do appear important to regulation of cell function and host defenses. The therapeutic potential of the
prostaglandins seems to be immense, and their use in a wide variety of clinical conditions is just beginning. Whether they will also prove helpful clinically as modulators of the immune response is not clear. It is likely that an appropriate balance of
prostaglandin endoperoxides,
thromboxanes,
prostacyclins, and probably the stable
prostaglandins themselves is important to physiologic regulation of many organ systems and of immunologic reactions. Thus, development of drugs that selectively inhibit one or another of the
prostaglandins and their allied compounds may prove fruitful in treatment of many diseases, including those associated with disordered immunity and tissue injury.
Prostaglandin therapy in such diseases must proceed with caution. In recent studies addition of
amantadine to
prostaglandin E (
PGE) treatment of NZB/W mice not only increased survival of these animals, but prevented development of circulating
antibodies to nuclear constituents including native
DNA. The results are encouraging, but must be balanced against the observation that deprivation of
prostaglandin precursors also prevented
nephritis and markedly increased surival of lupus mice. However,
prostaglandins might be useful in a disorder whose course is more easily monitored than that of
systemic lupus erythematosus:
cutaneous vasculitis. The studies in which even
oral administration of a
PGE1 derivative suppressed
immune complex-induced
vasculitis (reversed passive
Arthus reaction in rat skin) suggest that a trial of
PGE1 treatment of
cutaneous vasculitis would not be unreasonable.