The Prostacyclin Story: From Discovery to Future Directions

Until recent years, the concept of treating pulmonary arterial hypertension through a variety of mediators and mechanisms seemed beyond our grasp. As much as it is routinely done in other illnesses, the possibility of applying this concept in pulmonary hypertension was remote. This picture has radically changed, however, with the introduction of new agents that may be used in conjunction with prostacyclin and its analogs. The revolution in therapy started with the man profiled in this issue, Sir John Vane, a Nobel Prize winner recognized for his work in prostaglandin research.

Perhaps the theme of this issue should be that the revolution continues. After paying a debt of gratitude to Dr Vane, our story about prostacyclin continues throughout this issue. We explore the need to develop prostacyclin analogs to overcome the limitations of the epoprostenol delivery system, elaborate on the intriguing work with inhaled iloprost, and round it up with a roundtable discussion ranging across the spectrum of issues involving prostacyclin. We are also grateful to Bruce Brundage, MD, president of the Pulmonary Hypertension Association, who provided the images for this issue's cover.

Slowly, but with encouraging progress, we are getting to the point where we will better understand how to treat pulmonary arterial hypertension through a variety of mediators and mechanisms. There is still much to be discovered about prostacyclin—for example, how precisely does the medication work? When we discover its true mechanisms and determine how it can be used in combination with other treatments, perhaps the revolution in therapy will have achieved its goals.