Shoko Hase

Inhibition of both COX-1 and COX-2 is required for development of gastric damage in response to nonsteroidal antiinflammatory drugs.

We examined the gastric ulcerogenic property of selective COX-1 and/or COX-2 inhibitors in rats, and investigated whether COX-1 inhibition is by itself sufficient for induction of gastric damage. Animals fasted for 18 h were given various COX inhibitors p.o., either alone or in combination, and they were killed 8 h later. The nonselective COX inhibitors such as indomethacin, naproxen and dicrofenac inhibited PG production, increased gastric motility, and provoked severe gastric lesions. In contrast, the selective COX-2 inhibitor rofecoxib did not induce any damage in the stomach, with no effect on the mucosal PGE(2) contents and gastric motility. Likewise, the selective COX-1 inhibitor SC-560 also did not cause gastric damage, despite causing a significant decrease in PGE(2) contents. The combined administration of SC-560 and rofecoxib, however, provoked gross damage in the gastric mucosa, in a dose-dependent manner. SC-560 also caused a marked gastric hypermotility, whereas rofecoxib had no effect on basal gastric motor activity. On the other hand, the COX-2 mRNA was expressed in the stomach after administration of SC-560, while the normal gastric mucosa expressed only COX-1 mRNA but not COX-2 mRNA. These results suggest that the gastric ulcerogenic property of conventional NSAIDs is not accounted for solely by COX-1 inhibition and requires the inhibition of both COX-1 and COX-2. The inhibition of COX-1 up-regulates the COX-2 expression, and this may counteract the deleterious influences, such as gastric hypermotility and the subsequent events, due to a PG deficiency caused by COX-1 inhibition.

Role of Cyclooxygenase (COX)-1 and COX-2 Inhibition in Nonsteroidal Anti-Inflammatory Drug-Induced Intestinal Damage in Rats: Relation to Various Pathogenic Events

We recently reported that cyclooxygenase (COX)-2 expression was up-regulated in the rat small intestine after administration of indomethacin, and this may be a key to nonsteroidal anti-inflammatory drug (NSAID)-induced intestinal damage. In the present study, we investigated the effect of inhibiting COX-1 or COX-2 on various intestinal events occurring in association with NSAID-induced intestinal damage. Rats without fasting were treated with indomethacin, SC-560 (a selective COX-1 inhibitor), rofecoxib (a selective COX-2 inhibitor), or SC-560 plus rofecoxib, and the following parameters were examined in the small intestine: the lesion score, the enterobacterial number, myeloperoxidase (MPO) and inducible nitric-oxide synthase (iNOS) activity, and intestinal motility. Indomethacin decreased mucosal prostaglandin (PG)E2 content and caused damage in the intestine within 24 h, accompanied by an increase in intestinal contractility, bacterial numbers, and MPO as well as iNOS activity, together with the up-regulation of COX-2 and iNOS mRNA expression. Neither SC-560 nor rofecoxib alone caused intestinal damage, but their combined administration produced lesions. SC-560, but not rofecoxib, caused intestinal hypermotility, bacterial invasion, and COX-2 as well as iNOS mRNA expression, yet the iNOS and MPO activity was increased only when rofecoxib was also administered. Although SC-560 inhibited the PG production, the level of PGE2 was restored 6 h later, in a rofecoxib-dependent manner. We conclude that inhibition of COX-1, despite causing intestinal hypermotility, bacterial invasion, and iNOS expression, up-regulates the expression of COX-2, and the PGE2 produced by COX-2 counteracts deleterious events, and maintains the mucosal integrity. This sequence of events explains why intestinal damage occurs only when both COX-1 and COX-2 are inhibited.

Up-regulation of COX-2 by inhibition of COX-1 in the rat: a key to NSAID-induced gastric injury

A recent study demonstrated that inhibition of both cyclooxygenase (COX)‐1 and COX‐2 is required for the development of nonsteroidal anti‐inflammatory drug (NSAID)‐induced gastric lesions. However, the role of COX‐1 or COX‐2 inhibition in the pathogenisis of these lesions remains unclear.

Lack of small intestinal ulcerogenecity of nitric oxide‐releasing indomethacin, NCX‐530, in rats

To evaluate the intestinal ulcerogenic property of nitric oxide‐releasing indomethacin (NCX‐530) in the rat, in comparison with indomethacin.

Protection by aspirin of indomethacin-induced small intestinal damage in rats: mediation by salicylic acid

Most of non-steroidal anti-inflammatory drugs (NSAIDs) except aspirin (ASA) produce intestinal damage in rats. In the present study, we re-examined the intestinal toxic effect of ASA in rats, in comparison with various NSAIDs, and investigated why ASA does not cause damage in the small intestine, in relation to its metabolite salicylic acid (SA). Various NSAIDs (indomethacin; 10 mg/kg; flurbiprofen; 20 mg/kg; naproxen; 40 mg/kg; dicrofenac; 40 mg/kg; ASA; 20-200 mg/kg) were administered s.c., and the small intestinal mucosa was examined macroscopically 24 h later. All NSAIDs tested, except ASA, caused hemorrhagic lesions in the small intestine, with a decrease of mucosal PGE(2) contents. ASA did not provoke any damage, despite inhibiting (prostaglandin) PG production, and prevented the occurrence of intestinal lesions induced by indomethacin, in a dose-related manner. This protective action of ASA was mimicked by the equimolar doses of SA (17.8-178 mg/kg). Indomethacin caused intestinal hypermotility, in preceding to the occurrence of lesion, and this event was followed by increases of enterobacterial translocation in the mucosa. Both ASA and SA prevented both the intestinal hypermotility and the bacterial translocation seen after indomethacin treatment. In addition, the protective effect of SA was not significantly influenced by either the adenosine deaminase or the adenosine receptor antagonists. Following administration of ASA, the blood SA levels reached a peak within 30 min and remained elevated for more than 7 h. These results suggest that SA has a cytoprotective action against indomethacin-induced small intestinal lesions, and this action may be associated with inhibition of the intestinal hypermotility and the bacterial translocation, but not mediated by endogenous adenosine. Failure of ASA to induce intestinal damage may be explained, at least partly, by a protective action of SA, the metabolite of ASA.

Prostaglandin EP receptor subtypes and gastric cytoprotection

This article reviews recent studies dealing with the relationship between the cytoprotective action of PGE2 and the EP receptor subtypes in the gastric mucosa. Gastric cytoprotection afforded by PGE2 was mimicked by EP1 agonists and attenuated by the EP1 antagonist. Likewise, the adaptive cytoprotection induced by a mild irritant was attenuated by the EP1 antagonist and indomethacin. By contrast, capsaicin-induced protection was mitigated by indomethacin as well as sensory deafferentation but not by the EP1 antagonist. PGE2 failed to provide both direct and adaptive cytoprotection in EP1-receptor knockout mice, while capsaicin-induced protection was observed in the animals lacking either EP1 or EP3 receptors but disappeared in IP receptor knockout mice. We conclude that PGs, either generated endogenously or administered exogenously, exhibit gastric cytoprotection directly through activation of EP1 receptors, and endogenous PGs also contribute to the mucosal protection induced by capsaicin by sensitizing sensory neurons, probably through IP receptors.

Induction of Small Intestinal Damage by Inhibition of Both NO Synthase and COX-2

Non-steroidal antiinflammatory drugs (NSAIDs) such as indomethacin cause intestinal ulceration as an adverse effect (2,3). Prostaglandin (PG) deficiency caused by cyclooxygenase-1 (COX-1) is considered to play a critical role in the pathogenesis of these lesions. However, recent studies showed that inhibition of both COX-1 and COX-2 is required for induction of damage in the gastrointestinal mucosa following administration of NSAIDs (4, 5, 6). Since inhibition of COX-1 was accompanied by the mucosal expression of COX-2 (4), it is assumed that PGs produced by COX-2 contribute to the mucosal integrity by antagonizing deleterious events caused by inhibition of COX-1.