Update on endothelins - biology and clinical implications.

In the decade since the initial discovery and characterization of endothelin, its biology as a powerful vasoconstrictor has been dramatically demonstrated. Studies have clarified the existence of endothelin isoforms, complex mechanisms of biosynthesis, interaction with specific receptors, and pathogenic implications. We are on the brink of using endothelin antagonism as a clinical treatment for disease processes where endothelin plays an important role, including congestive heart failure and hypertension. Novel observations have been made about the unexpectedly profound contribution endothelins make to normal fetal maturation, especially in cardiac and enteric development.