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Chapter: Basic & Clinical Pharmacology : Drug Receptors & Pharmacodynamics

Well-Established Second Messengers

Well-Established Second Messengers
A. Cyclic Adenosine Monophosphate (cAMP) B. Phosphoinositides and Calcium C. Cyclic Guanosine Monophosphate (cGMP)

Well-Established Second Messengers

A. Cyclic Adenosine Monophosphate (cAMP)

Acting as an intracellular second messenger, cAMP mediates such hormonal responses as the mobilization of stored energy (the breakdown of carbohydrates in liver or triglycerides in fat cells stimulated by β-adrenomimetic catecholamines), conservation of water by the kidney (mediated by vasopressin), Ca2+ homeostasis (regulated by parathyroid hormone), and increased rate and con-tractile force of heart muscle (β-adrenomimetic catecholamines). It also regulates the production of adrenal and sex steroids (in response to corticotropin or follicle-stimulating hormone), relax-ation of smooth muscle, and many other endocrine and neural processes.

cAMP exerts most of its effects by stimulating cAMP-dependent protein kinases (Figure 2–13). These kinases are composed of a cAMP-binding regulatory (R) dimer and two catalytic (C) chains. When cAMP binds to the R dimer, active C chains are released to diffuse through the cytoplasm and nucleus, where they transfer phosphate from ATP to appropriate substrate proteins, often enzymes. The specificity of the regulatory effects of cAMP resides in the distinct protein substrates of the kinases that are expressed in different cells. For example, liver is rich in phosphorylase kinase and glycogen synthase, enzymes whose reciprocal regulation by cAMP-dependent phosphorylation governs carbohydrate storage and release.

When the hormonal stimulus stops, the intracellular actions of cAMP are terminated by an elaborate series of enzymes. cAMP-stimulated phosphorylation of enzyme substrates is rapidly reversed by a diverse group of specific and nonspecific phos-phatases. cAMP itself is degraded to 5-AMP by several cyclic nucleotide phosphodiesterases (PDE; Figure 2–13). Milrinone, a selective inhibitor of type 3 phosphodiesterases that are expressed in cardiac muscle cells, has been used as an adjunctive agent in treating acute heart failure. Competitive inhibition of cAMP deg-radation is one way that caffeine, theophylline, and other meth-ylxanthines produce their effects .

B. Phosphoinositides and Calcium

Another well-studied second messenger system involves hormonal stimulation of phosphoinositide hydrolysis (Figure 2–14). Some of the hormones, neurotransmitters, and growth factors that trig-ger this pathway bind to receptors linked to G proteins, whereas others bind to receptor tyrosine kinases. In all cases, the crucial step is stimulation of a membrane enzyme, phospholipase C (PLC), which splits a minor phospholipid component of the plasma membrane, phosphatidylinositol-4,5-bisphosphate (PIP2), into two second messengers, diacylglycerol (DAG) and inositol-1,4,5-trisphosphate (IP3or InsP3). Diacylglycerol is confined tothe membrane, where it activates a phospholipid- and calcium-sensitive protein kinase called protein kinase C. IP3 is water-solu-ble and diffuses through the cytoplasm to trigger release of Ca2+ by binding to ligand-gated calcium channels in the limiting mem-branes of internal storage vesicles. Elevated cytoplasmic Ca2+ concentration resulting from IP3-promoted opening of these channels promotes the binding of Ca2+ to the calcium-binding protein calmodulin, which regulates activities of other enzymes, including calcium-dependent protein kinases.

With its multiple second messengers and protein kinases, the phosphoinositide signaling pathway is much more complex than the cAMP pathway. For example, different cell types may con-tain one or more specialized calcium- and calmodulin-dependent kinases with limited substrate specificity (eg, myosin light-chain kinase) in addition to a general calcium- and calmodulin-dependent kinase that can phosphorylate a wide variety of protein substrates. Furthermore, at least nine structurally distinct types of protein kinase C have been identified.

As in the cAMP system, multiple mechanisms damp or termi-nate signaling by this pathway. IP3 is inactivated by dephosphory-lation; diacylglycerol is either phosphorylated to yield phosphatidic acid, which is then converted back into phospholipids, or it is deacylated to yield arachidonic acid; Ca2+ is actively removed from the cytoplasm by Ca2+ pumps.

These and other nonreceptor elements of the calcium-phos-phoinositide signaling pathway are of considerable importance in pharmacotherapy. For example, lithium ion, used in treatment of bipolar (manic-depressive) disorder, affects the cellular metabo-lism of phosphoinositides .

C. Cyclic Guanosine Monophosphate (cGMP)

Unlike cAMP, the ubiquitous and versatile carrier of diverse mes-sages, cGMP has established signaling roles in only a few cell types. In intestinal mucosa and vascular smooth muscle, the cGMP-based signal transduction mechanism closely parallels the cAMP-mediated signaling mechanism. Ligands detected by cell-surface receptors stimulate membrane-bound guanylyl cyclase to produce cGMP, and cGMP acts by stimulating a cGMP-dependent protein kinase. The actions of cGMP in these cells are terminated by enzymatic degradation of the cyclic nucleotide and by dephos-phorylation of kinase substrates.

Increased cGMP concentration causes relaxation of vascular smooth muscle by a kinase-mediated mechanism that results in dephosphorylation of myosin light chains (see Figure 12–2). In these smooth muscle cells, cGMP synthesis can be elevated by two transmembrane signaling mechanisms utilizing two different gua-nylyl cyclases. Atrial natriuretic peptide, a blood-borne peptide hormone, stimulates a transmembrane receptor by binding to its extracellular domain, thereby activating the guanylyl cyclase activ-ity that resides in the receptor’s intracellular domain. The other mechanism mediates responses to nitric oxide (NO;), which is generated in vascular endothelial cells in response to natural vasodilator agents such as acetylcholine and histamine. After entering the target cell, nitric oxide binds to and activates a cytoplasmic guanylyl cyclase (see Figure 19–2). A number of use-ful vasodilating drugs, such as nitroglycerin and sodium nitroprus-side used in treating cardiac ischemia and acute hypertension, act by generating or mimicking nitric oxide. Other drugs produce vasodilation by inhibiting specific phosphodiesterases, thereby interfering with the metabolic breakdown of cGMP. One such drug is sildenafil, used in treating erectile dysfunction and pulmo-nary hypertension .

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