Prostacyclin is an antithrombotic hormone produced by the endothelium, whose production is dependent on cyclooxygenase (COX) enzymes of which two isoforms exist. It is widely believed that COX-2 drives prostacyclin production and that this explains the cardiovascular toxicity associated with COX-2 inhibition, yet the evidence for this relies on indirect evidence from urinary metabolites. Here we have used a range of experimental approaches to explore which isoform drives the production of prostacyclin in vitro and in vivo. Our data show unequivocally that under physiological conditions it is COX-1 and not COX-2 that drives prostacyclin production in the cardiovascular system, and that urinary metabolites do not reflect prostacyclin production in the systemic circulation. With the idea that COX-2 in endothelium drives prostacyclin production in healthy individuals removed, we must seek new answers to why COX-2 inhibitors increase the risk of cardiovascular events to move forward with drug discovery and to enable more informed prescribing advice.
There are two schools of thought regarding the cyclooxygenase (COX) isoform
active in the vasculature. Using urinary prostacyclin markers some groups have
proposed that vascular COX-2 drives prostacyclin release. In contrast, we and
others have found that COX-1, not COX-2, is responsible for vascular
prostacyclin production. Our experiments have relied on immunoassays to detect
the prostacyclin breakdown product, 6-keto-PGF1α and antibodies to
detect COX-2 protein. Whilst these are standard approaches, used by many
laboratories, antibody-based techniques are inherently indirect and have been
criticized as limiting the conclusions that can be drawn. To address this
question, we measured production of prostanoids, including
6-keto-PGF1α, by isolated vessels and in the circulation
in vivo using liquid chromatography tandem mass
spectrometry and found values essentially identical to those obtained by
immunoassay. In addition, we determined expression from the
Cox2 gene using a knockin reporter mouse in which
luciferase activity reflects Cox2 gene expression. Using this
we confirm the aorta to be essentially devoid of Cox2 driven
expression. In contrast, thymus, renal medulla, and regions of the brain and gut
expressed substantial levels of luciferase activity, which correlated well with
COX-2-dependent prostanoid production. These data are consistent with the
conclusion that COX-1 drives vascular prostacyclin release and puts the sparse
expression of Cox2 in the vasculature in the context of the
rest of the body. In doing so, we have identified the thymus, gut, brain and
other tissues as target organs for consideration in developing a new
understanding of how COX-2 protects the cardiovascular system.
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