Paracrine signaling allows cells to communicate with their immediate neighbors via secretion of signaling molecules. The signal only triggers a response in nearby target cells as the signal molecules degrade quickly or are inactivated by nearby cells if not taken up. Prominent examples of paracrine signaling include nitric oxide signaling in blood vessels, synaptic signaling of neurons, the blood clotting system, tissue repair/wound healing, and local allergic skin reactions.
One of the essential paracrine signaling molecules is the gas nitric oxide (NO). Nitric oxide is produced by a family of enzymes known as nitric oxide synthases.
Blood vessels contain several layers of cells. The innermost layer of cells is the endothelium. Endothelial cells have nitric oxide synthase, which produces nitric oxide that diffuses in all directions. The nitric oxide that reaches the blood does not contribute to signaling but immediately reacts with biochemicals, such as hemoglobin. Nitric oxide molecules that diffuse in the opposite direction, towards the next layer of the blood vessel, participate in some important signaling.
The layer just exterior to the endothelium is made up of smooth muscle cells. The function of smooth muscle cells is to contract. When these cells contract, they clamp down on the blood vessel, narrowing its diameter and consequently raising blood pressure.
Nitric oxide facilitates the relaxation of smooth muscle cells by engaging in paracrine signaling. This involves nitric oxide binding to guanylate cyclase receptors, which results in increased levels of cyclic guanosine monophosphate (cGMP) in the smooth muscle cells. This leads to smooth muscle relaxation, increasing the vessel diameter. This process is known as dilation, and it lowers blood pressure.
When a blood vessel is damaged and begins to bleed, this means the endothelium has been broken. Broken endothelial tissue releases von Willebrand factor (vWF), which binds to platelets—small white blood cells without nuclei—circulating in the blood. This is a form of paracrine signaling. Meanwhile, collagen fibers under the endothelial cells also bind to platelets. Several other platelet proteins are subsequently activated and released by the platelets. These proteins, in turn, activate more platelets via paracrine signaling. A complex series of reactions between many clotting factors forms a substance known as fibrin, which holds the blood clot together and patches the broken endothelium.
In 1978, Robert Furchgott discovered a substance that he called “Endothelium-Derived Relaxing Factor.” By the mid-1980s, he had determined that this substance was nitric oxide. Meanwhile, Louis Ignarro independently made the same discovery, and Ferid Murad demonstrated that nitric oxide raises cyclic GMP levels. For this work, Furchgott, Ignarro, and Murad received a shared Nobel Prize in 1998.
In 1989, researchers working for Pfizer developed the drug sildenafil as a blood pressure medication. It quickly became apparent that sildenafil had notable effects on erections, which sparked interest in the drug’s potential to treat erectile dysfunction. Erectile dysfunction is a frequent health problem in middle-aged and older men. This condition occurs due to high blood pressure which affects penile blood vessels. The reason is that the corpus cavernosum (the most blood-filled part of the penis) produces phosphodiesterase type 5 (PDE5). This enzyme specifically degrades cGMP. The new drug potently inhibited PDE5, explaining its activity. Sildenafil was given the brand name Viagra, and sales took off.
