Platelet-activating factor (PAF) is a phospho lipid mediator (1-O-alkyl-2-acetyl-sn-glyceryl-3-phosphoryl choline) 1-3 named after its activity in itially described on platelets. 4 However, over the past 10 years, several other biologic activities for this mediator have been reported (reviewed by Braquet et al 5,6 ). From quantitative structure to activity re lationships, a model for the putative PAF receptor (or binding site) on platelets has been developed, 7,8 involving a hydrophobic pocket in which the alkyl chain is engaged and a recognition site for the acetyl moiety. Since 1984, several PAF antagonists ob tained from vegetable sources have been described, including kadsurenone, [9][10][11] and endogenous lignans 12 and the ginkgolide compounds (reviewed by Braquet et al 6 ). These substances have been shown to inhibit and reverse the binding of [ 3 H]-PAF to in tact platelets or membranes. In addition to the de scription of natural PAF antagonists, the knowledge of the possible structure of the recognition site for PAF on platelets has led to the development of various synthetic antagonists of the phospholipid mediator (reviewed by Braquet et al 6 ). The use of synthetic and natural PAF antagonists in diverse ex perimental and clinical models has allowed a better understanding of the role of this autacoid in throm botic and vascular diseases. The aim of the present review is to update the knowledge on the effects of PAF, especially those on platelets and vascular endothelium.
MECHANISMS OF THE ACTION OF PLATELET-ACTIVATING FACTORSince platelet activation by thrombin is not in hibited by adenosine diphosphate (ADP), scaveng ing agents and cyclooxygenase blockers, a "third pathway of platelet aggregation" was postulated. [13][14][15] In 1979, Chignard et al [16][17][18][19][20][21][22] demonstrated that a sub stance identical to PAF is secreted into the supernatants of rabbit platelets stimulated with the Ca ++ ionophore A23187, thrombin, or collagen, suggest ing that PAF could be the actual mediator of the third pathway of activation. 17-21,23 PAF is also re leased by human platelets stimulated with the cal cium ionophore or thrombin, 1924 particularly when its degradation and subsequent incorporation into the platelet membrane as an acylated derivative are prevented by an acetylhydrolase inhibitor. 24 In hu mans, however, it is unclear if PAF acts as a primary aggregating agent, since PAF-induced platelet ag gregation is markedly inhibited by ADP scavengers such as creatine phosphate-creatine phosphokinase complex or apyrase. In addition, recent results show that PAF antagonists fail to interfere with thrombininduced aggregation of aspirin-treated human platelets depleted of their ADP-containing dense bodies by a snake venom component. 25 Since the dif ferences observed between rabbit and human plate lets may rely on possible alterations due to the purification procedure and the use of anticoagu lants, further studies are required to ascertain the precise contribution of PAF in the aggregation pro cess in...