Indomethacin exerts a strong tocolytic effect by suppressing uterine contractions mediated by prostaglandins. However, indomethacin also induces in utero closure of fetal ductus arteriosus (DA), leading to serious neonatal consequences. Using rats, we tested the effect of an agonist for a subtype of prostaglandin E2 receptor (EP4), ONO-AE1-437 and its prodrug ONO-4819, as a DA dilator during indomethacin treatment. In vitro, ONO-AE1-437 exhibited a potent dilatory effect on DA against O 2 -and indomethacin-induced contractions in a concentration-dependent manner. In vivo, rat dams were given indomethacin (10 mg/kg, p.o.) alone or with ONO-4819 (0.3 g/kg/h, s.c.) on d 21 of gestation and pups were delivered 4 h later through cesarean section to evaluate the ratio of diameter of DA to that of pulmonary artery. Pups from dams with no drug had DA/PA ratio of 0.9 Ϯ 0.05, whereas those from dams with indomethacin alone had a decreased ratio of 0.2 Ϯ 0.03. When ONO-4819 was co-administered to the dams, the ratio recovered significantly to 0.7 Ϯ 0.06. The administration of ONO-4819 to the dams did not induce any increase in the uterine activity. These results suggest that administration of an EP4 agonist in addition to indomethacin might prevent adverse reactions of indomethacin on fetal DA without restricting its tocolytic effects. In the late gestational period, PG play key roles in the physiologic processes leading to labor. In the mother, PG are key players in the initiation and progression of parturition (1,2), whereas in the fetus they participate in the regulation of circulatory change at birth. In this regulation, the closure of the DA is a critical event (3). DA functions in utero as a shunt vessel that connects the PA and the systemic circulation, bypassing the unexpanded fetal lungs. After birth, the DA closes rapidly as pulmonary circulation is established. The fetal DA is normally maintained patent by dilators, of which PGE 2 is a major mediator that is supplied mainly by the placenta (3). At birth, the increase in oxygen tension along with the drop in PGE 2 level in neonatal circulation, which follow initiation of pulmonary respiration and placental segregation, respectively, result in postnatal closure of DA (3). Four subtypes of PGE 2 receptor have been identified, designated EP1, EP2, EP3, and EP4 (4). Although the distribution of PG receptors shows variation among species, EP4 has been shown to be a primary receptor subtype of PGE 2 at fetal DA in several mammals (5-7). In the case of humans, data are available only at neonatal DA in which EP4 is also a major receptor subtype of PGE 2 (8). Mice lacking EP4 gene died of patent DA soon after birth (9,10), implying an additional function of EP4 as a sensor of circulating PGE 2 to prepare DA closure after birth.Indomethacin is an NSAID that suppresses prostanoid synthesis by inhibiting COX. In the context of preterm labor, there is some controversy as to whether NSAID are a useful therapeutic choice, despite their tocolytic effect, because morbid neonatal ...