Understanding the role of prostaglandin E2 in regulating human platelet activity in health and disease

• Human platelet’s response to PGE2 segregates in two phenotypic groups
• PGE2 effects on mouse platelets cannot be translated to human platelets
• Studies must use PGE2 rather than receptor-specific agonist because of biased agonism
• Published data in platelets are inconsistent from lack of standardized protocols
• PGE2 receptors could be new targets for antiplatelet drugs that preserve hemostasis

The platelet thrombus is the major pathologic entity in acute coronary syndromes, and antiplatelet agents are a mainstay of therapy. However, individual patient responsiveness to current antiplatelet drugs is variable, and all drugs carry a risk of bleeding. An understanding of the complex role of Prostaglandin E2 (PGE2) in regulating thrombosis offers opportunities for the development of novel individualized antiplatelet treatment. However, deciphering the platelet regulatory function of PGE2 has long been confounded by non-standardized experimental conditions, extrapolation of murine data to humans, and phenotypic differences in PGE2 response. This review synthesizes past and current knowledge about PGE2 effects on platelet biology, presents a rationale for standardization of experimental protocols, and provides insight into a molecular mechanism by which PGE2-activated pathways could be targeted for new personalized antiplatelet therapy to inhibit pathologic thrombosis without affecting hemostasis.