Reflections on possible mechanisms of action of anti-inflammatory drugs

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Abstract
A personal over-view of the various postulated modes of action of the anti-inflammatory drugs is presented. Particular reference is made to the relevance of the individual findings to a clinical context. A critical review of the significance of uncoupling of oxidative-phosphorylation is presented. The numerous chemical mediators of the inflammatory response, including the biologically-active amines, kinins, prostaglandins, and cyclic AMP are discussed, and recent time course observations of the appearance of these substances on the scene in inflammatory reactions are reviewed. The all-embracing theory of the lysosomal membrane and enzyme involvement in the inflammatory response is critically discussed and comment is made on the possible role of other cellular enzymes, including hepatic microsomal enzyme and myeloperoxidase. Protein binding effects and the conjectured role of natural antiinflammatory substances is presented in relation to L tryptophan in rheumatoid arthritis. The relationships and roles of phagocytic cells and of the immunologically competent T and B cells in the inflammatory response are reviewed with particular reference to the action of some anti-inflammatory drugs upon these cells and upon the complement coagulation and fibrinolytic systems.

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