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Cyclooxygenase-2

Cyclooxygenase-2 (COX-2), also known as Prostaglandin-endoperoxide synthase 2 (HUGO PTGS2), is an enzyme that in humans is encoded by the PTGS2 gene.[5] In humans it is one of two cyclooxygenases. It is involved in the conversion of arachidonic acid to prostaglandin H2, an important precursor of prostacyclin, which is expressed in inflammation.

PTGS2
Available structures
PDBOrtholog search: PDBe RCSB
Identifiers
AliasesPTGS2, COX-2, COX2, GRIPGHS, PGG/HS, PGHS-2, PHS-2, hCox-2, prostaglandin-endoperoxide synthase 2
External IDsOMIM: 600262 MGI: 97798 HomoloGene: 31000 GeneCards: PTGS2
EC number1.14.99.1
Orthologs
SpeciesHumanMouse
Entrez
Ensembl
UniProt
RefSeq (mRNA)

NM_000963

NM_011198

RefSeq (protein)

NP_000954

NP_035328

Location (UCSC)Chr 1: 186.67 – 186.68 MbChr 1: 149.98 – 149.98 Mb
PubMed search[3][4]
Wikidata
View/Edit HumanView/Edit Mouse

Function edit

PTGS2 (COX-2), converts arachidonic acid (AA) to prostaglandin endoperoxide H2. PTGSs are targets for NSAIDs and PTGS2 (COX-2) specific inhibitors called coxibs. PTGS-2 is a sequence homodimer. Each monomer of the enzyme has a peroxidase and a PTGS (COX) active site. The PTGS (COX) enzymes catalyze the conversion of arachidonic acid to prostaglandins in two steps. First, hydrogen is abstracted from carbon 13 of arachidonic acid, and then two molecules of oxygen are added by the PTGS2 (COX-2), giving PGG2. Second, PGG2 is reduced to PGH2 in the peroxidase active site. The synthesized PGH2 is converted to prostaglandins (PGD2, PGE2, PGF), prostacyclin (PGI2), or thromboxane A2 by tissue-specific isomerases.(Figure 2)[6]

While metabolizing arachidonic acid primarily to PGG2, COX-2 also converts this fatty acid to small amounts of a racemic mixture of 15-Hydroxyicosatetraenoic acids (i.e., 15-HETEs) composed of ~22% 15(R)-HETE and ~78% 15(S)-HETE stereoisomers as well as a small amount of 11(R)-HETE.[7] The two 15-HETE stereoisomers have intrinsic biological activities but, perhaps more importantly, can be further metabolized to a major class of agents, the lipoxins. Furthermore, aspirin-treated COX-2 metabolizes arachidonic acid almost exclusively to 15(R)-HETE which product can be further metabolized to epi-lipoxins.[8] The lipoxins and epi-lipoxins are potent anti-inflammatory agents and may contribute to the overall activities of the two COX's as well as to aspirin.[citation needed]

COX-2 is naturally inhibited by calcitriol (the active form of Vitamin D).[9][10]

Mechanism edit

 
Arachidonic acid bound to the PTGS2 (COX-2) enzyme. Polar interactions between arachidonic acid (cyan) and Ser-530 and Tyr-385 residues are shown with yellow dashed lines. The substrate is stabilized by hydrophobic interactions.[11]
 
Mechanism of COX activation and catalysis. A hydroperoxide oxidizes the heme to a ferryl-oxo derivative that either is reduced in the first step of the peroxidase cycle or oxidizes Tyrosine 385 to a tyrosyl radical. The tyrosyl radical can then oxidize the 13-pro(S) hydrogen of arachidonic acid to initiate the COX cycle.

Both the peroxidase and PTGS activities are inactivated during catalysis by mechanism-based, first-order processes, which means that PGHS-2 peroxidase or PTGS activities fall to zero within 1–2 minutes, even in the presence of sufficient substrates.[12][13][14]

The conversion of arachidonic acid to PGG2 can be shown as a series of radical reactions analogous to polyunsaturated fatty acid autoxidation.[15] The 13-pro(S) -hydrogen is abstracted and dioxygen traps the pentadienyl radical at carbon 11. The 11-peroxyl radical cyclizes at carbon 9 and the carbon-centered radical generated at C-8 cyclizes at carbon 12, generating the endoperoxide. The allylic radical generated is trapped by dioxygen at carbon 15 to form the 15-(S) -peroxyl radical; this radical is then reduced to PGG2 . This is supported by the following evidence: 1) a significant kinetic isotope effect is observed for the abstraction of the 13-pro (S)-hydrogen; 2) carbon-centered radicals are trapped during catalysis;[16] 3) small amounts of oxidation products are formed due to the oxygen trapping of an allylic radical intermediate at positions 13 and 15.[17][18]

Another mechanism in which the 13-pro (S)-hydrogen is deprotonated and the carbanion is oxidized to a radical is theoretically possible. However, oxygenation of 10,10-difluoroarachidonic acid to 11-(S)-hydroxyeicosa-5,8,12,14-tetraenoic acid is not consistent with the generation of a carbanion intermediate because it would eliminate fluoride to form a conjugated diene.[19] The absence of endoperoxide-containing products derived from 10,10-difluoroarachidonic acid has been thought to indicate the importance of a C-10 carbocation in PGG2 synthesis.[20] However, the cationic mechanism requires that endoperoxide formation comes before the removal of the 13-pro (S)-hydrogen. This is not consistent with the results of the isotope experiments of arachidonic acid oxygenation.[21]

Structure edit

 
As shown, different ligands bind either the allosteric or the catalytic subunit. Allosteric subunit binds a non-substrate, activating FA (e.g., palmitic acid). The allosteric subunit with bound fatty acid activates the catalytic subunit by decreasing the Km for AA.[22]

PTGS2 (COX-2) exists as a homodimer, each monomer with a molecular mass of about 70 kDa. The tertiary and quaternary structures of PTGS1 (COX-1) and PTGS2 (COX-2) enzymes are almost identical. Each subunit has three different structural domains: a short N-terminal epidermal growth factor (EGF) domain; an α-helical membrane-binding moiety; and a C-terminal catalytic domain. PTGS (COX, which can be confused with "cytochrome oxidase") enzymes are monotopic membrane proteins; the membrane-binding domain consists of a series of amphipathic α helices with several hydrophobic amino acids exposed to a membrane monolayer. PTGS1 (COX-1) and PTGS2 (COX-2) are bifunctional enzymes that carry out two consecutive chemical reactions in spatially distinct but mechanistically coupled active sites. Both the cyclooxygenase and the peroxidase active sites are located in the catalytic domain, which accounts for approximately 80% of the protein. The catalytic domain is homologous to mammalian peroxidases such as myeloperoxidase.[23][24]

It has been found that human PTGS2 (COX-2) functions as a conformational heterodimer having a catalytic monomer (E-cat) and an allosteric monomer (E-allo). Heme binds only to the peroxidase site of E-cat while substrates, as well as certain inhibitors (e.g. celecoxib), bind the COX site of E-cat. E-cat is regulated by E-allo in a way dependent on what ligand is bound to E-allo. Substrate and non-substrate fatty acid (FAs) and some PTGS (COX) inhibitors (e.g. naproxen) preferentially bind to the PTGS (COX) site of E-allo. Arachidonic acid can bind to E-cat and E-allo, but the affinity of AA for E-allo is 25 times that for Ecat. Palmitic acid, an efficacious stimulator of huPGHS-2, binds only E-allo in palmitic acid/murine PGHS-2 co-crystals. Non-substrate FAs can potentiate or attenuate PTGS (COX) inhibitors depending on the fatty acid and whether the inhibitor binds E-cat or E-allo. Studies suggest that the concentration and composition of the free fatty acid pool in the environment in which PGHS-2 functions in cells, also referred to as the FA tone, is a key factor regulating the activity of PGHS-2 and its response to PTGS (COX) inhibitors.[22]

Clinical significance edit

 
NSAID (non-specific inhibitor of PTGS2 (COX-2)) flurbiprofen (green) bound to PTGS2 (COX-2). Flurbiprofen is stabilized via hydrophobic interactions and polar interactions (Tyr-355 and Arg-120).[25]

PTGS2 (COX-2) is unexpressed under normal conditions in most cells, but elevated levels are found during inflammation. PTGS1 (COX-1) is constitutively expressed in many tissues and is the predominant form in gastric mucosa and in the kidneys. Inhibition of PTGS1 (COX-1) reduces the basal production of cytoprotective PGE2 and PGI2 in the stomach, which may contribute to gastric ulceration. Since PTGS2 (COX-2) is generally expressed only in cells where prostaglandins are upregulated (e.g., during inflammation), drug-candidates that selectively inhibit PTGS2 (COX-2) were suspected to show fewer side-effects[24] but proved to substantially increase risk for cardiovascular events such as heart attack and stroke. Two different mechanisms may explain contradictory effects. Low-dose aspirin protects against heart attacks and strokes by blocking PTGS1 (COX-1) from forming a prostaglandin called thromboxane A2. It sticks platelets together and promotes clotting; inhibiting this helps prevent heart disease. On the other hand, PTGS2 (COX-2) is a more important source of prostaglandins, particularly prostacyclin which is found in blood vessel lining. Prostacyclin relaxes or unsticks platelets, so selective COX-2 inhibitors (coxibs) increase risk of cardiovascular events due to clotting.[26]

Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin production by PTGS1 (COX-1) and PTGS2 (COX-2). NSAIDs selective for inhibition of PTGS2 (COX-2) are less likely than traditional drugs to cause gastrointestinal adverse effects, but could cause cardiovascular events, such as heart failure, myocardial infarction, and stroke. Studies with human pharmacology and genetics, genetically manipulated rodents, and other animal models and randomized trials indicate that this is due to suppression of PTGS2 (COX-2)-dependent cardioprotective prostaglandins, prostacyclin in particular.[27]

The expression of PTGS2 (COX-2) is upregulated in many cancers. The overexpression of PTGS2 (COX-2) along with increased angiogenesis and SLC2A1 (GLUT-1) expression is significantly associated with gallbladder carcinomas.[28] Furthermore, the product of PTGS2 (COX-2), PGH2 is converted by prostaglandin E2 synthase into PGE2, which in turn can stimulate cancer progression. Consequently, inhibiting PTGS2 (COX-2) may have benefit in the prevention and treatment of these types of cancer.[29][30]

COX-2 expression was found in human idiopathic epiretinal membranes.[31] Cyclooxygenases blocking by lornoxicam in acute stage of inflammation reduced the frequency of membrane formation by 43% in the dispase model of PVR and by 31% in the concanavalin one. Lornoxicam not only normalized the expression of cyclooxygenases in both models of PVR, but also neutralized the changes of the retina and the choroid thickness caused by the injection of pro-inflammatory agents. These facts underline the importance of cyclooxygenases and prostaglandins in the development of PVR.[32]

PTGS2 gene upregulation has also been linked with multiple stages of human reproduction. Presence of gene is found in the chorionic plate, in the amnion epithelium, syncytiotrophoblasts, villous fibroblasts, chorionic trophoblasts, amniotic trophoblasts, as well as the basal plate of the placenta, in the decidual cells and extravillous cytotrophoblasts. During the process of chorioamnionitis/deciduitis, the upregulation of PTGS2 in the amnion and choriodecidua is one of three limited effects of inflammation in the uterus. Increased expression of the PTGS2 gene in the fetal membranes is connected to the presence of inflammation, causing uterine prostaglandin gene expression and immunolocalization of prostaglandin pathway proteins in chorionic trophoblast cells and adjacent decidua, or choriodecidua. PTGS2 is linked with the inflammatory system and has been observed in inflammatory leukocytes. It has been noted that there is a positive correlation with PTGS2 expression in the amnion during spontaneous labour and was discovered to have increased expression with gestational age following the presence of labour with no change observed in amnion and choriodecidua during either preterm or term labour. Additionally, oxytocin stimulates the expression of PTGS2 in myometrial cells.[33]

The mutant allele PTGS2 5939C carriers among the Han Chinese population have been shown to have a higher risk of gastric cancer. In addition, a connection was found between Helicobacter pylori infection and the presence of the 5939C allele.[34]

Interactions edit

PTGS2 has been shown to interact with caveolin 1.[35]

History edit

PTGS2 (COX-2) was discovered in 1991 by the Daniel Simmons laboratory[36][better source needed] at Brigham Young University.

See also edit

References edit

  1. ^ a b c GRCh38: Ensembl release 89: ENSG00000073756 - Ensembl, May 2017
  2. ^ a b c GRCm38: Ensembl release 89: ENSMUSG00000032487 - Ensembl, May 2017
  3. ^ "Human PubMed Reference:". National Center for Biotechnology Information, U.S. National Library of Medicine.
  4. ^ "Mouse PubMed Reference:". National Center for Biotechnology Information, U.S. National Library of Medicine.
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  6. ^ O'Banion MK (1999). "Cyclooxygenase-2: molecular biology, pharmacology, and neurobiology". Crit Rev Neurobiol. 13 (1): 45–82. doi:10.1615/critrevneurobiol.v13.i1.30. PMID 10223523.
  7. ^ Mulugeta S, Suzuki T, Hernandez NT, Griesser M, Boeglin WE, Schneider C (2010). "Identification and absolute configuration of dihydroxy-arachidonic acids formed by oxygenation of 5S-HETE by native and aspirin-acetylated COX-2". J. Lipid Res. 51 (3): 575–85. doi:10.1194/jlr.M001719. PMC 2817587. PMID 19752399.
  8. ^ Serhan CN (2005). "Lipoxins and aspirin-triggered 15-epi-lipoxins are the first lipid mediators of endogenous anti-inflammation and resolution". Prostaglandins Leukot. Essent. Fatty Acids. 73 (3–4): 141–62. doi:10.1016/j.plefa.2005.05.002. PMID 16005201.
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  11. ^ PDB: 3OLT
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  21. ^ Hamberg M, Samuelsson B (November 1967). "On the mechanism of the biosynthesis of prostaglandins E-1 and F-1-alpha". J. Biol. Chem. 242 (22): 5336–43. doi:10.1016/S0021-9258(18)99433-0. PMID 6070851.
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  25. ^ PDB: 3PGH
  26. ^ Ruan CH, So SP, Ruan KH (2011). "Inducible COX-2 dominates over COX-1 in prostacyclin biosynthesis: Mechanisms of COX-2 inhibitor risk to heart disease". Life Sciences. 88 (1–2): 24–30. doi:10.1016/j.lfs.2010.10.017. PMC 3046773. PMID 21035466.
  27. ^ Wang D, Patel VV, Ricciotti E, Zhou R, Levin MD, Gao E, Yu Z, Ferrari VA, Lu MM, Xu J, Zhang H, Hui Y, Cheng Y, Petrenko N, Yu Y, FitzGerald GA (May 2009). "Cardiomyocyte cyclooxygenase-2 influences cardiac rhythm and function". Proc. Natl. Acad. Sci. U.S.A. 106 (18): 7548–52. Bibcode:2009PNAS..106.7548W. doi:10.1073/pnas.0805806106. PMC 2670242. PMID 19376970.
  28. ^ Legan M (August 2010). "Cyclooxygenase-2, p53 and glucose transporter-1 as predictors of malignancy in the development of gallbladder carcinomas". Bosn J Basic Med Sci. 10 (3): 192–6. doi:10.17305/bjbms.2010.2684. PMC 5504494. PMID 20846124.
  29. ^ EntrezGene 5743
  30. ^ Menter DG, Schilsky RL, DuBois RN (March 2010). "Cyclooxygenase-2 and cancer treatment: understanding the risk should be worth the reward". Clin. Cancer Res. 16 (5): 1384–90. doi:10.1158/1078-0432.CCR-09-0788. PMC 4307592. PMID 20179228.
  31. ^ KASE S, SAITO W, OHNO S, ISHIDA S (2010). "Cyclo-Oxygenase-2 Expression in Human Idiopathic Epiretinal Membrane". Retina. 30 (5): 719–723. doi:10.1097/iae.0b013e3181c59698. PMID 19996819. S2CID 205650971.
  32. ^ Tikhonovich MV, Erdiakov AK, Gavrilova SA (2017-06-21). "Nonsteroid anti-inflammatory therapy suppresses the development of proliferative vitreoretinopathy more effectively than a steroid one". International Ophthalmology. 38 (4): 1365–1378. doi:10.1007/s10792-017-0594-3. ISSN 0165-5701. PMID 28639085. S2CID 4017540.
  33. ^ Phillips, Robert J et al. "Prostaglandin pathway gene expression in human placenta, amnion and choriodecidua is differentially affected by preterm and term labour and by uterine inflammation." BMC pregnancy and childbirth vol. 14 241. 22 Jul. 2014, doi:10.1186/1471-2393-14-241
  34. ^ Li Y, He W, Liu T, Zhang Q (December 2010). "A new cyclo-oxygenase-2 gene variant in the Han Chinese population is associated with an increased risk of gastric carcinoma". Mol Diagn Ther. 14 (6): 351–5. doi:10.1007/bf03256392. PMID 21275453. S2CID 1229751.
  35. ^ Liou JY, Deng WG, Gilroy DW, Shyue SK, Wu KK (September 2001). "Colocalization and interaction of cyclooxygenase-2 with caveolin-1 in human fibroblasts". J. Biol. Chem. 276 (37): 34975–82. doi:10.1074/jbc.M105946200. PMID 11432874.
  36. ^ Xie WL, Chipman JG, Robertson DL, Erikson RL, Simmons DL (April 1991). "Expression of a mitogen-responsive gene encoding prostaglandin synthase is regulated by mRNA splicing". Proc. Natl. Acad. Sci. U.S.A. 88 (7): 2692–6. Bibcode:1991PNAS...88.2692X. doi:10.1073/pnas.88.7.2692. PMC 51304. PMID 1849272.

Further reading edit

  • Richards JA, Petrel TA, Brueggemeier RW (February 2002). "Signaling pathways regulating aromatase and cyclooxygenases in normal and malignant breast cells". J. Steroid Biochem. Mol. Biol. 80 (2): 203–12. doi:10.1016/S0960-0760(01)00187-X. PMID 11897504. S2CID 12728545.
  • Wu T, Wu H, Wang J, Wang J (2011). "Expression and cellular localization of cyclooxygenases and prostaglandin E synthases in the hemorrhagic brain". J Neuroinflammation. 8: 22. doi:10.1186/1742-2094-8-22. PMC 3062590. PMID 21385433.
  • Koki AT, Khan NK, Woerner BM, Seibert K, Harmon JL, Dannenberg AJ, Soslow RA, Masferrer JL (January 2002). "Characterization of cyclooxygenase-2 (COX-2) during tumorigenesis in human epithelial cancers: evidence for potential clinical utility of COX-2 inhibitors in epithelial cancers". Prostaglandins Leukot. Essent. Fatty Acids. 66 (1): 13–8. doi:10.1054/plef.2001.0335. PMID 12051953.
  • Saukkonen K, Rintahaka J, Sivula A, Buskens CJ, Van Rees BP, Rio MC, Haglund C, Van Lanschot JJ, Offerhaus GJ, Ristimaki A (October 2003). "Cyclooxygenase-2 and gastric carcinogenesis". APMIS. 111 (10): 915–25. doi:10.1034/j.1600-0463.2003.1111001.x. PMID 14616542. S2CID 23257867.
  • Sinicrope FA, Gill S (2004). "Role of cyclooxygenase-2 in colorectal cancer". Cancer Metastasis Rev. 23 (1–2): 63–75. doi:10.1023/A:1025863029529. PMID 15000150. S2CID 21521040.
  • Jain S, Khuri FR, Shin DM (2004). "Prevention of head and neck cancer: current status and future prospects". Curr Probl Cancer. 28 (5): 265–86. doi:10.1016/j.currproblcancer.2004.05.003. PMID 15375804.
  • Saba N, Jain S, Khuri F (2004). "Chemoprevention in lung cancer". Curr Probl Cancer. 28 (5): 287–306. doi:10.1016/j.currproblcancer.2004.05.005. PMID 15375805.
  • Cardillo I, Spugnini EP, Verdina A, Galati R, Citro G, Baldi A (October 2005). "Cox and mesothelioma: an overview". Histol. Histopathol. 20 (4): 1267–74. PMID 16136507.
  • Brueggemeier RW, Díaz-Cruz ES (March 2006). "Relationship between aromatase and cyclooxygenases in breast cancer: potential for new therapeutic approaches". Minerva Endocrinol. 31 (1): 13–26. PMID 16498361.
  • Fujimura T, Ohta T, Oyama K, Miyashita T, Miwa K (March 2006). "Role of cyclooxygenase-2 in the carcinogenesis of gastrointestinal tract cancers: a review and report of personal experience". World J. Gastroenterol. 12 (9): 1336–45. doi:10.3748/wjg.v12.i9.1336. PMC 4124307. PMID 16552798.
  • Bingham S, Beswick PJ, Blum DE, Gray NM, Chessell IP (October 2006). "The role of the cylooxygenase pathway in nociception and pain". Semin. Cell Dev. Biol. 17 (5): 544–54. doi:10.1016/j.semcdb.2006.09.001. PMID 17071117.
  • Minghetti L, Pocchiari M (2007). Cyclooxygenase-2, prostaglandin E2, and microglial activation in prion diseases. International Review of Neurobiology. Vol. 82. pp. 265–75. doi:10.1016/S0074-7742(07)82014-9. ISBN 978-0-12-373989-6. PMID 17678966. {{cite book}}: |journal= ignored (help)

External links edit

  • Nextbio 2019-10-18 at the Wayback Machine
  • NSAIDs and Cardiovascular Risk Explained, According to Studies from the Perelman School of Medicine
  • Wolfe MM (December 2004). "Rofecoxib, Merck, and the FDA". N. Engl. J. Med. 351 (27): 2875–8, author reply 2875–8. doi:10.1056/NEJM200412303512719. PMID 15625749.

cyclooxygenase, redirects, here, cox2, cytochrome, oxidase, subunit, also, known, prostaglandin, endoperoxide, synthase, hugo, ptgs2, enzyme, that, humans, encoded, ptgs2, gene, humans, cyclooxygenases, involved, conversion, arachidonic, acid, prostaglandin, i. COX 2 redirects here For COX2 see Cytochrome c oxidase subunit 2 Cyclooxygenase 2 COX 2 also known as Prostaglandin endoperoxide synthase 2 HUGO PTGS2 is an enzyme that in humans is encoded by the PTGS2 gene 5 In humans it is one of two cyclooxygenases It is involved in the conversion of arachidonic acid to prostaglandin H2 an important precursor of prostacyclin which is expressed in inflammation PTGS2Available structuresPDBOrtholog search PDBe RCSBList of PDB id codes5F1A 5F19 5IKQ 5IKT 5IKV 5IKRIdentifiersAliasesPTGS2 COX 2 COX2 GRIPGHS PGG HS PGHS 2 PHS 2 hCox 2 prostaglandin endoperoxide synthase 2External IDsOMIM 600262 MGI 97798 HomoloGene 31000 GeneCards PTGS2EC number1 14 99 1Gene location Human Chr Chromosome 1 human 1 Band1q31 1Start186 671 791 bp 1 End186 680 922 bp 1 Gene location Mouse Chr Chromosome 1 mouse 2 Band1 G1 1 63 84 cMStart149 975 782 bp 2 End149 983 978 bp 2 RNA expression patternBgeeHumanMouse ortholog Top expressed inseminal vesiculamucosa of urinary bladderperiodontal fibervena cavavisceral pleurasaphenous veingallbladdergastric mucosamonocytebone marrow cellsTop expressed indentate gyruscumulus cellright lung lobecalvariahippocampus properRegion I of hippocampus properprefrontal cortexpineal glandsubiculumpiriform cortexMore reference expression dataBioGPSMore reference expression dataGene ontologyMolecular functionarachidonate 15 lipoxygenase activity metal ion binding heme binding enzyme binding oxidoreductase activity protein homodimerization activity dioxygenase activity protein binding peroxidase activity prostaglandin endoperoxide synthase activity oxidoreductase activity acting on single donors with incorporation of molecular oxygen incorporation of two atoms of oxygen transferase activityCellular componentcytoplasm endoplasmic reticulum lumen membrane caveola neuron projection organelle membrane endoplasmic reticulum intracellular membrane bounded organelle endoplasmic reticulum membrane protein containing complexBiological processresponse to fructose learning response to organic substance lipoxygenase pathway cellular response to mechanical stimulus response to manganese ion angiogenesis cellular response to hypoxia embryo implantation negative regulation of cell population proliferation response to cytokine negative regulation of smooth muscle contraction memory response to oxidative stress maintenance of blood brain barrier response to lithium ion response to tumor necrosis factor fatty acid biosynthetic process positive regulation of synaptic transmission glutamatergic positive regulation of vasoconstriction response to organonitrogen compound inflammatory response positive regulation of smooth muscle contraction bone mineralization response to fatty acid response to vitamin D cellular response to UV positive regulation of fever generation cellular response to fluid shear stress positive regulation of synaptic plasticity regulation of blood pressure response to lipopolysaccharide positive regulation of platelet derived growth factor production regulation of inflammatory response brown fat cell differentiation sensory perception of pain response to radiation prostaglandin biosynthetic process cellular response to ATP ovulation positive regulation of smooth muscle cell proliferation hair cycle response to estradiol positive regulation of cell death positive regulation of cell migration involved in sprouting angiogenesis response to organic cyclic compound lipid metabolism positive regulation of nitric oxide biosynthetic process response to glucocorticoid cyclooxygenase pathway fatty acid metabolic process positive regulation of fibroblast growth factor production decidualization regulation of cell population proliferation positive regulation of cell population proliferation negative regulation of calcium ion transport positive regulation of apoptotic process positive regulation of transforming growth factor beta production positive regulation of vascular endothelial growth factor production positive regulation of brown fat cell differentiation negative regulation of synaptic transmission dopaminergic cellular oxidant detoxification human ageing NAD biosynthesis via nicotinamide riboside salvage pathway cellular response to heat positive regulation of prostaglandin biosynthetic process positive regulation of peptidyl serine phosphorylation negative regulation of apoptotic process negative regulation of cysteine type endopeptidase activity involved in apoptotic process cellular response to non ionic osmotic stress negative regulation of intrinsic apoptotic signaling pathway in response to osmotic stress cellular response to lead ion response to angiotensin prostaglandin metabolic process positive regulation of protein import into nucleus cytokine mediated signaling pathway long chain fatty acid biosynthetic process negative regulation of cell cycle regulation of neuroinflammatory responseSources Amigo QuickGOOrthologsSpeciesHumanMouseEntrez574319225EnsemblENSG00000073756ENSMUSG00000032487UniProtP35354Q05769RefSeq mRNA NM 000963NM 011198RefSeq protein NP 000954NP 035328Location UCSC Chr 1 186 67 186 68 MbChr 1 149 98 149 98 MbPubMed search 3 4 WikidataView Edit HumanView Edit Mouse Contents 1 Function 2 Mechanism 3 Structure 4 Clinical significance 5 Interactions 6 History 7 See also 8 References 9 Further reading 10 External linksFunction editPTGS2 COX 2 converts arachidonic acid AA to prostaglandin endoperoxide H2 PTGSs are targets for NSAIDs and PTGS2 COX 2 specific inhibitors called coxibs PTGS 2 is a sequence homodimer Each monomer of the enzyme has a peroxidase and a PTGS COX active site The PTGS COX enzymes catalyze the conversion of arachidonic acid to prostaglandins in two steps First hydrogen is abstracted from carbon 13 of arachidonic acid and then two molecules of oxygen are added by the PTGS2 COX 2 giving PGG2 Second PGG2 is reduced to PGH2 in the peroxidase active site The synthesized PGH2 is converted to prostaglandins PGD2 PGE2 PGF2a prostacyclin PGI2 or thromboxane A2 by tissue specific isomerases Figure 2 6 While metabolizing arachidonic acid primarily to PGG2 COX 2 also converts this fatty acid to small amounts of a racemic mixture of 15 Hydroxyicosatetraenoic acids i e 15 HETEs composed of 22 15 R HETE and 78 15 S HETE stereoisomers as well as a small amount of 11 R HETE 7 The two 15 HETE stereoisomers have intrinsic biological activities but perhaps more importantly can be further metabolized to a major class of agents the lipoxins Furthermore aspirin treated COX 2 metabolizes arachidonic acid almost exclusively to 15 R HETE which product can be further metabolized to epi lipoxins 8 The lipoxins and epi lipoxins are potent anti inflammatory agents and may contribute to the overall activities of the two COX s as well as to aspirin citation needed COX 2 is naturally inhibited by calcitriol the active form of Vitamin D 9 10 Mechanism edit nbsp Arachidonic acid bound to the PTGS2 COX 2 enzyme Polar interactions between arachidonic acid cyan and Ser 530 and Tyr 385 residues are shown with yellow dashed lines The substrate is stabilized by hydrophobic interactions 11 nbsp Mechanism of COX activation and catalysis A hydroperoxide oxidizes the heme to a ferryl oxo derivative that either is reduced in the first step of the peroxidase cycle or oxidizes Tyrosine 385 to a tyrosyl radical The tyrosyl radical can then oxidize the 13 pro S hydrogen of arachidonic acid to initiate the COX cycle Both the peroxidase and PTGS activities are inactivated during catalysis by mechanism based first order processes which means that PGHS 2 peroxidase or PTGS activities fall to zero within 1 2 minutes even in the presence of sufficient substrates 12 13 14 The conversion of arachidonic acid to PGG2 can be shown as a series of radical reactions analogous to polyunsaturated fatty acid autoxidation 15 The 13 pro S hydrogen is abstracted and dioxygen traps the pentadienyl radical at carbon 11 The 11 peroxyl radical cyclizes at carbon 9 and the carbon centered radical generated at C 8 cyclizes at carbon 12 generating the endoperoxide The allylic radical generated is trapped by dioxygen at carbon 15 to form the 15 S peroxyl radical this radical is then reduced to PGG2 This is supported by the following evidence 1 a significant kinetic isotope effect is observed for the abstraction of the 13 pro S hydrogen 2 carbon centered radicals are trapped during catalysis 16 3 small amounts of oxidation products are formed due to the oxygen trapping of an allylic radical intermediate at positions 13 and 15 17 18 Another mechanism in which the 13 pro S hydrogen is deprotonated and the carbanion is oxidized to a radical is theoretically possible However oxygenation of 10 10 difluoroarachidonic acid to 11 S hydroxyeicosa 5 8 12 14 tetraenoic acid is not consistent with the generation of a carbanion intermediate because it would eliminate fluoride to form a conjugated diene 19 The absence of endoperoxide containing products derived from 10 10 difluoroarachidonic acid has been thought to indicate the importance of a C 10 carbocation in PGG2 synthesis 20 However the cationic mechanism requires that endoperoxide formation comes before the removal of the 13 pro S hydrogen This is not consistent with the results of the isotope experiments of arachidonic acid oxygenation 21 Structure edit nbsp As shown different ligands bind either the allosteric or the catalytic subunit Allosteric subunit binds a non substrate activating FA e g palmitic acid The allosteric subunit with bound fatty acid activates the catalytic subunit by decreasing the Km for AA 22 PTGS2 COX 2 exists as a homodimer each monomer with a molecular mass of about 70 kDa The tertiary and quaternary structures of PTGS1 COX 1 and PTGS2 COX 2 enzymes are almost identical Each subunit has three different structural domains a short N terminal epidermal growth factor EGF domain an a helical membrane binding moiety and a C terminal catalytic domain PTGS COX which can be confused with cytochrome oxidase enzymes are monotopic membrane proteins the membrane binding domain consists of a series of amphipathic a helices with several hydrophobic amino acids exposed to a membrane monolayer PTGS1 COX 1 and PTGS2 COX 2 are bifunctional enzymes that carry out two consecutive chemical reactions in spatially distinct but mechanistically coupled active sites Both the cyclooxygenase and the peroxidase active sites are located in the catalytic domain which accounts for approximately 80 of the protein The catalytic domain is homologous to mammalian peroxidases such as myeloperoxidase 23 24 It has been found that human PTGS2 COX 2 functions as a conformational heterodimer having a catalytic monomer E cat and an allosteric monomer E allo Heme binds only to the peroxidase site of E cat while substrates as well as certain inhibitors e g celecoxib bind the COX site of E cat E cat is regulated by E allo in a way dependent on what ligand is bound to E allo Substrate and non substrate fatty acid FAs and some PTGS COX inhibitors e g naproxen preferentially bind to the PTGS COX site of E allo Arachidonic acid can bind to E cat and E allo but the affinity of AA for E allo is 25 times that for Ecat Palmitic acid an efficacious stimulator of huPGHS 2 binds only E allo in palmitic acid murine PGHS 2 co crystals Non substrate FAs can potentiate or attenuate PTGS COX inhibitors depending on the fatty acid and whether the inhibitor binds E cat or E allo Studies suggest that the concentration and composition of the free fatty acid pool in the environment in which PGHS 2 functions in cells also referred to as the FA tone is a key factor regulating the activity of PGHS 2 and its response to PTGS COX inhibitors 22 Clinical significance edit nbsp NSAID non specific inhibitor of PTGS2 COX 2 flurbiprofen green bound to PTGS2 COX 2 Flurbiprofen is stabilized via hydrophobic interactions and polar interactions Tyr 355 and Arg 120 25 PTGS2 COX 2 is unexpressed under normal conditions in most cells but elevated levels are found during inflammation PTGS1 COX 1 is constitutively expressed in many tissues and is the predominant form in gastric mucosa and in the kidneys Inhibition of PTGS1 COX 1 reduces the basal production of cytoprotective PGE2 and PGI2 in the stomach which may contribute to gastric ulceration Since PTGS2 COX 2 is generally expressed only in cells where prostaglandins are upregulated e g during inflammation drug candidates that selectively inhibit PTGS2 COX 2 were suspected to show fewer side effects 24 but proved to substantially increase risk for cardiovascular events such as heart attack and stroke Two different mechanisms may explain contradictory effects Low dose aspirin protects against heart attacks and strokes by blocking PTGS1 COX 1 from forming a prostaglandin called thromboxane A2 It sticks platelets together and promotes clotting inhibiting this helps prevent heart disease On the other hand PTGS2 COX 2 is a more important source of prostaglandins particularly prostacyclin which is found in blood vessel lining Prostacyclin relaxes or unsticks platelets so selective COX 2 inhibitors coxibs increase risk of cardiovascular events due to clotting 26 Non steroidal anti inflammatory drugs NSAIDs inhibit prostaglandin production by PTGS1 COX 1 and PTGS2 COX 2 NSAIDs selective for inhibition of PTGS2 COX 2 are less likely than traditional drugs to cause gastrointestinal adverse effects but could cause cardiovascular events such as heart failure myocardial infarction and stroke Studies with human pharmacology and genetics genetically manipulated rodents and other animal models and randomized trials indicate that this is due to suppression of PTGS2 COX 2 dependent cardioprotective prostaglandins prostacyclin in particular 27 The expression of PTGS2 COX 2 is upregulated in many cancers The overexpression of PTGS2 COX 2 along with increased angiogenesis and SLC2A1 GLUT 1 expression is significantly associated with gallbladder carcinomas 28 Furthermore the product of PTGS2 COX 2 PGH2 is converted by prostaglandin E2 synthase into PGE2 which in turn can stimulate cancer progression Consequently inhibiting PTGS2 COX 2 may have benefit in the prevention and treatment of these types of cancer 29 30 COX 2 expression was found in human idiopathic epiretinal membranes 31 Cyclooxygenases blocking by lornoxicam in acute stage of inflammation reduced the frequency of membrane formation by 43 in the dispase model of PVR and by 31 in the concanavalin one Lornoxicam not only normalized the expression of cyclooxygenases in both models of PVR but also neutralized the changes of the retina and the choroid thickness caused by the injection of pro inflammatory agents These facts underline the importance of cyclooxygenases and prostaglandins in the development of PVR 32 PTGS2 gene upregulation has also been linked with multiple stages of human reproduction Presence of gene is found in the chorionic plate in the amnion epithelium syncytiotrophoblasts villous fibroblasts chorionic trophoblasts amniotic trophoblasts as well as the basal plate of the placenta in the decidual cells and extravillous cytotrophoblasts During the process of chorioamnionitis deciduitis the upregulation of PTGS2 in the amnion and choriodecidua is one of three limited effects of inflammation in the uterus Increased expression of the PTGS2 gene in the fetal membranes is connected to the presence of inflammation causing uterine prostaglandin gene expression and immunolocalization of prostaglandin pathway proteins in chorionic trophoblast cells and adjacent decidua or choriodecidua PTGS2 is linked with the inflammatory system and has been observed in inflammatory leukocytes It has been noted that there is a positive correlation with PTGS2 expression in the amnion during spontaneous labour and was discovered to have increased expression with gestational age following the presence of labour with no change observed in amnion and choriodecidua during either preterm or term labour Additionally oxytocin stimulates the expression of PTGS2 in myometrial cells 33 The mutant allele PTGS2 5939C carriers among the Han Chinese population have been shown to have a higher risk of gastric cancer In addition a connection was found between Helicobacter pylori infection and the presence of the 5939C allele 34 Interactions editPTGS2 has been shown to interact with caveolin 1 35 History editPTGS2 COX 2 was discovered in 1991 by the Daniel Simmons laboratory 36 better source needed at Brigham Young University See also editArachidonic acid Cyclooxygenase Cyclooxygenase 1 NSAID Discovery and development of COX 2 selective inhibitors COX 2 selective inhibitorReferences edit a b c GRCh38 Ensembl release 89 ENSG00000073756 Ensembl May 2017 a b c GRCm38 Ensembl release 89 ENSMUSG00000032487 Ensembl May 2017 Human PubMed Reference National Center for Biotechnology Information U S National Library of Medicine Mouse PubMed Reference National Center for Biotechnology Information U S National Library of Medicine Hla T Neilson K August 1992 Human cyclooxygenase 2 cDNA Proc Natl Acad Sci U S A 89 16 7384 8 Bibcode 1992PNAS 89 7384H doi 10 1073 pnas 89 16 7384 PMC 49714 PMID 1380156 O Banion MK 1999 Cyclooxygenase 2 molecular biology pharmacology and neurobiology Crit Rev Neurobiol 13 1 45 82 doi 10 1615 critrevneurobiol v13 i1 30 PMID 10223523 Mulugeta S Suzuki T Hernandez NT Griesser M Boeglin WE Schneider C 2010 Identification and absolute configuration of dihydroxy arachidonic acids formed by oxygenation of 5S HETE by native and aspirin acetylated COX 2 J Lipid Res 51 3 575 85 doi 10 1194 jlr M001719 PMC 2817587 PMID 19752399 Serhan CN 2005 Lipoxins and aspirin triggered 15 epi lipoxins are the first lipid mediators of endogenous anti inflammation and resolution Prostaglandins Leukot Essent Fatty Acids 73 3 4 141 62 doi 10 1016 j plefa 2005 05 002 PMID 16005201 Wang Q1 He Y Shen Y Zhang Q Chen D Zuo C Qin J Wang H Wang J Yu Y 2014 Vitamin D inhibits COX 2 expression and inflammatory response by targeting thioesterase superfamily member 4 J Biol Chem 289 17 11681 11694 doi 10 1074 jbc M113 517581 PMC 4002078 PMID 24619416 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint numeric names authors list link Kassi E1 Adamopoulos C Basdra EK Papavassiliou AG 2013 Role of Vitamin D in Atherosclerosis Circulation 128 23 2517 2531 doi 10 1161 CIRCULATIONAHA 113 002654 PMID 24297817 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint numeric names authors list link PDB 3OLT Smith WL Garavito RM DeWitt DL December 1996 Prostaglandin endoperoxide H synthases cyclooxygenases 1 and 2 J Biol Chem 271 52 33157 60 doi 10 1074 jbc 271 52 33157 PMID 8969167 Wu G Wei C Kulmacz RJ Osawa Y Tsai AL April 1999 A mechanistic study of self inactivation of the peroxidase activity in prostaglandin H synthase 1 J Biol Chem 274 14 9231 7 doi 10 1074 jbc 274 14 9231 PMID 10092596 Callan OH So OY Swinney DC February 1996 The kinetic factors that determine the affinity and selectivity for slow binding inhibition of human prostaglandin H synthase 1 and 2 by indomethacin and flurbiprofen J Biol Chem 271 7 3548 54 doi 10 1074 jbc 271 7 3548 PMID 8631960 Porter NA 1986 Mechanisms for the autoxidation of polyunsaturated lipids Accounts of Chemical Research 19 9 262 8 doi 10 1021 ar00129a001 Mason RP Kalyanaraman B Tainer BE Eling TE June 1980 A carbon centered free radical intermediate in the prostaglandin synthetase oxidation of arachidonic acid Spin trapping and oxygen uptake studies J Biol Chem 255 11 5019 22 doi 10 1016 S0021 9258 19 70741 8 PMID 6246094 Hecker M Ullrich V Fischer C Meese CO November 1987 Identification of novel arachidonic acid metabolites formed by prostaglandin H synthase Eur J Biochem 169 1 113 23 doi 10 1111 j 1432 1033 1987 tb13587 x PMID 3119336 Xiao G Tsai AL Palmer G Boyar WC Marshall PJ Kulmacz RJ February 1997 Analysis of hydroperoxide induced tyrosyl radicals and lipoxygenase activity in aspirin treated human prostaglandin H synthase 2 Biochemistry 36 7 1836 45 doi 10 1021 bi962476u PMID 9048568 Kwok PY Muellner FW Fried J June 1987 Enzymatic conversions of 10 10 difluoroarachidonic acid with PGH synthase and soybean lipoxygenase Journal of the American Chemical Society 109 12 3692 3698 doi 10 1021 ja00246a028 Dean AM Dean FM May 1999 Carbocations in the synthesis of prostaglandins by the cyclooxygenase of PGH synthase A radical departure Protein Sci 8 5 1087 98 doi 10 1110 ps 8 5 1087 PMC 2144324 PMID 10338019 Hamberg M Samuelsson B November 1967 On the mechanism of the biosynthesis of prostaglandins E 1 and F 1 alpha J Biol Chem 242 22 5336 43 doi 10 1016 S0021 9258 18 99433 0 PMID 6070851 a b Dong L Vecchio AJ Sharma NP Jurban BJ Malkowski MG Smith WL May 2011 Human cyclooxygenase 2 is a sequence homodimer that functions as a conformational heterodimer J Biol Chem 286 21 19035 46 doi 10 1074 jbc M111 231969 PMC 3099718 PMID 21467029 Picot D Loll PJ Garavito RM January 1994 The X ray crystal structure of the membrane protein prostaglandin H2 synthase 1 Nature 367 6460 243 9 Bibcode 1994Natur 367 243P doi 10 1038 367243a0 PMID 8121489 S2CID 4340064 a b Kurumbail RG Kiefer JR Marnett LJ December 2001 Cyclooxygenase enzymes catalysis and inhibition Curr Opin Struct Biol 11 6 752 60 doi 10 1016 S0959 440X 01 00277 9 PMID 11751058 PDB 3PGH Ruan CH So SP Ruan KH 2011 Inducible COX 2 dominates over COX 1 in prostacyclin biosynthesis Mechanisms of COX 2 inhibitor risk to heart disease Life Sciences 88 1 2 24 30 doi 10 1016 j lfs 2010 10 017 PMC 3046773 PMID 21035466 Wang D Patel VV Ricciotti E Zhou R Levin MD Gao E Yu Z Ferrari VA Lu MM Xu J Zhang H Hui Y Cheng Y Petrenko N Yu Y FitzGerald GA May 2009 Cardiomyocyte cyclooxygenase 2 influences cardiac rhythm and function Proc Natl Acad Sci U S A 106 18 7548 52 Bibcode 2009PNAS 106 7548W doi 10 1073 pnas 0805806106 PMC 2670242 PMID 19376970 Legan M August 2010 Cyclooxygenase 2 p53 and glucose transporter 1 as predictors of malignancy in the development of gallbladder carcinomas Bosn J Basic Med Sci 10 3 192 6 doi 10 17305 bjbms 2010 2684 PMC 5504494 PMID 20846124 EntrezGene 5743 Menter DG Schilsky RL DuBois RN March 2010 Cyclooxygenase 2 and cancer treatment understanding the risk should be worth the reward Clin Cancer Res 16 5 1384 90 doi 10 1158 1078 0432 CCR 09 0788 PMC 4307592 PMID 20179228 KASE S SAITO W OHNO S ISHIDA S 2010 Cyclo Oxygenase 2 Expression in Human Idiopathic Epiretinal Membrane Retina 30 5 719 723 doi 10 1097 iae 0b013e3181c59698 PMID 19996819 S2CID 205650971 Tikhonovich MV Erdiakov AK Gavrilova SA 2017 06 21 Nonsteroid anti inflammatory therapy suppresses the development of proliferative vitreoretinopathy more effectively than a steroid one International Ophthalmology 38 4 1365 1378 doi 10 1007 s10792 017 0594 3 ISSN 0165 5701 PMID 28639085 S2CID 4017540 Phillips Robert J et al Prostaglandin pathway gene expression in human placenta amnion and choriodecidua is differentially affected by preterm and term labour and by uterine inflammation BMC pregnancy and childbirth vol 14 241 22 Jul 2014 doi 10 1186 1471 2393 14 241 Li Y He W Liu T Zhang Q December 2010 A new cyclo oxygenase 2 gene variant in the Han Chinese population is associated with an increased risk of gastric carcinoma Mol Diagn Ther 14 6 351 5 doi 10 1007 bf03256392 PMID 21275453 S2CID 1229751 Liou JY Deng WG Gilroy DW Shyue SK Wu KK September 2001 Colocalization and interaction of cyclooxygenase 2 with caveolin 1 in human fibroblasts J Biol Chem 276 37 34975 82 doi 10 1074 jbc M105946200 PMID 11432874 Xie WL Chipman JG Robertson DL Erikson RL Simmons DL April 1991 Expression of a mitogen responsive gene encoding prostaglandin synthase is regulated by mRNA splicing Proc Natl Acad Sci U S A 88 7 2692 6 Bibcode 1991PNAS 88 2692X doi 10 1073 pnas 88 7 2692 PMC 51304 PMID 1849272 Further reading editRichards JA Petrel TA Brueggemeier RW February 2002 Signaling pathways regulating aromatase and cyclooxygenases in normal and malignant breast cells J Steroid Biochem Mol Biol 80 2 203 12 doi 10 1016 S0960 0760 01 00187 X PMID 11897504 S2CID 12728545 Wu T Wu H Wang J Wang J 2011 Expression and cellular localization of cyclooxygenases and prostaglandin E synthases in the hemorrhagic brain J Neuroinflammation 8 22 doi 10 1186 1742 2094 8 22 PMC 3062590 PMID 21385433 Koki AT Khan NK Woerner BM Seibert K Harmon JL Dannenberg AJ Soslow RA Masferrer JL January 2002 Characterization of cyclooxygenase 2 COX 2 during tumorigenesis in human epithelial cancers evidence for potential clinical utility of COX 2 inhibitors in epithelial cancers Prostaglandins Leukot Essent Fatty Acids 66 1 13 8 doi 10 1054 plef 2001 0335 PMID 12051953 Saukkonen K Rintahaka J Sivula A Buskens CJ Van Rees BP Rio MC Haglund C Van Lanschot JJ Offerhaus GJ Ristimaki A October 2003 Cyclooxygenase 2 and gastric carcinogenesis APMIS 111 10 915 25 doi 10 1034 j 1600 0463 2003 1111001 x PMID 14616542 S2CID 23257867 Sinicrope FA Gill S 2004 Role of cyclooxygenase 2 in colorectal cancer Cancer Metastasis Rev 23 1 2 63 75 doi 10 1023 A 1025863029529 PMID 15000150 S2CID 21521040 Jain S Khuri FR Shin DM 2004 Prevention of head and neck cancer current status and future prospects Curr Probl Cancer 28 5 265 86 doi 10 1016 j currproblcancer 2004 05 003 PMID 15375804 Saba N Jain S Khuri F 2004 Chemoprevention in lung cancer Curr Probl Cancer 28 5 287 306 doi 10 1016 j currproblcancer 2004 05 005 PMID 15375805 Cardillo I Spugnini EP Verdina A Galati R Citro G Baldi A October 2005 Cox and mesothelioma an overview Histol Histopathol 20 4 1267 74 PMID 16136507 Brueggemeier RW Diaz Cruz ES March 2006 Relationship between aromatase and cyclooxygenases in breast cancer potential for new therapeutic approaches Minerva Endocrinol 31 1 13 26 PMID 16498361 Fujimura T Ohta T Oyama K Miyashita T Miwa K March 2006 Role of cyclooxygenase 2 in the carcinogenesis of gastrointestinal tract cancers a review and report of personal experience World J Gastroenterol 12 9 1336 45 doi 10 3748 wjg v12 i9 1336 PMC 4124307 PMID 16552798 Bingham S Beswick PJ Blum DE Gray NM Chessell IP October 2006 The role of the cylooxygenase pathway in nociception and pain Semin Cell Dev Biol 17 5 544 54 doi 10 1016 j semcdb 2006 09 001 PMID 17071117 Minghetti L Pocchiari M 2007 Cyclooxygenase 2 prostaglandin E2 and microglial activation in prion diseases International Review of Neurobiology Vol 82 pp 265 75 doi 10 1016 S0074 7742 07 82014 9 ISBN 978 0 12 373989 6 PMID 17678966 a href Template Cite book html title Template Cite book cite book a journal ignored help External links editNextbio Archived 2019 10 18 at the Wayback Machine NSAIDs and Cardiovascular Risk Explained According to Studies from the Perelman School of Medicine Wolfe MM December 2004 Rofecoxib Merck and the FDA N Engl J Med 351 27 2875 8 author reply 2875 8 doi 10 1056 NEJM200412303512719 PMID 15625749 Retrieved from https en wikipedia org w index php title Cyclooxygenase 2 amp oldid 1215921016, wikipedia, wiki, book, books, library,

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