Tohru Miyazawa

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.

16,16-Dimethyl Prostaglandin E2 Inhibits Indomethacin-Induced Small Intestinal Lesions Through EP3 and EP4 Receptors

We evaluated the effect of various PGE analogs specific to EP receptor subtypes on indomethacin-induced small intestinal lesions in rats and investigated the relationship of EP receptor subtype with the PGE action using EP receptor knockout mice. Animals were administered indomethacin subcutaneously, and they were killed 24 hr later. 16,16-dimethyl prostaglandin E2 (dmPGE2) or various EP agonists were administered intravenously 10 min before indomethacin. Indomethacin caused hemorrhagic lesions in the rat small intestine, accompanied with an increase in intestinal motility and the number of enteric bacteria as well as iNOS and MPO activities. Prior administration of dmPGE2 dose-dependently prevented intestinal lesions, together with inhibition of those functional changes. These effects of dmPGE2 were mimicked by prostanoids (ONO-NT-012 and ONO-AE1-329), only specific to EP3 or EP4 receptors, although the intestinal motility was inhibited only by ONO-AE1-329. Intestinal mucus secretion and fluid accumulation were decreased by indomethacin but enhanced by dmPGE2, ONO-NT-012, and ONO-AE1-329 at the doses that prevented intestinal lesions. Indomethacin also caused intestinal lesions in both wild-type and knockout mice lacking EP1 or EP3 receptors, yet the protective action of dmPGE2 was observed in wild-type and EP1 receptor knockout mice but not the mice lacking EP3 receptors. These results suggest that the intestinal cytoprotective action of PGE2 against indomethacin is mediated by EP3/EP4 receptors and that this effect is functionally associated with an increase of mucus secretion and enteropooling as well as inhibition of intestinal hypermotility, the former two processes mediated by both EP3 and EP4 receptors, and the latter by EP4 receptors.

Protection by constitutively formed nitric oxide of intestinal damage induced by indomethacin in rats.

In the present study, we investigated a protective role of constitutively occurred nitric oxide (NO) against indomethacin-induced intestinal lesions in rats. Indomethacin (10 mg/kg) was given s.c. to animals without fasting, and the intestinal mucosa was examined for lesions 24 h later. The NOS inhibitor N(G)-nitro-L-arginine methyl ester (L-NAME) was given s.c. 0.5 h before or 6 hr after indomethacin, while the NO donor (+/-)-(E)-ethyl-2-[(E)-hydroxyimino]-5-nitro-3-hexnamine (NOR-3) was given s.c. 0.5 h before indomethacin. Indomethacin caused hemorrhagic lesions in the small intestine, accompanied with an increase in intestinal motility and bacterial translocation. These lesions were markedly prevented or worsened, respectively, by later or prior administration of L-NAME (20 mg/kg), in a L-arginine-sensitive manner. The worsening effect of L-NAME (5-20 mg/kg) on these lesions was dose-dependently observed in association with further enhancement of the bacterial translocation and intestinal hypermotility following indomethacin. By contrast, prior administration of NOR-3 (1-6 mg/kg) dose-dependently prevented the development of intestinal lesions, together with suppression of the bacterial translocation and intestinal hypermotility in response to indomethacin. On the other hand, both indomethacin and L-NAME decreased intestinal mucus and fluid (water) secretion in the small intestine, while NOR-3 increased these secretions. These results suggest that (1) NO occurred constitutively exerts a protective action against indomethacin-induced intestinal ulceration, and (2) this effect is related with prevention of bacterial translocation, the process functionally associated with increase of mucus and fluid secretions as well as inhibition of intestinal hypermotility.

Both selective COX-1 and COX-2 inhibitors aggravate gastric damage induced in rats by 2-deoxy-D-glucose. relation to gastric hypermotility and COX-2 expression.

Background/Aim: 2-Deoxy-D-glucose (2DG), despite causing gastric hypermotility via vagal stimulation, does not by itself induce damage in the stomach but produces gross lesions under prostaglandin (PG) deficiency induced by non-ulcerogenic dose of indomethacin. In this study, we examined the roles PG and cyclo-oxygenase (COX) isozymes play in the gastric ulcerogenic effect of 2DG in the rat stomach under PG deficiency caused by indomethacin. Methods: The animals were given 2DG i.v. (200 mg/kg as a bolus injection followed by an infusion at 100 mg/kg), and the mucosa was examined for lesions 8 h later. SC-560 or/and rofecoxib was given p.o. 1 h before 2DG treatment. Results: 2DG alone caused slight damage in the stomach despite causing acid hypersecretion and hypermotility. Neither SC-560 nor rofecoxib alone caused any damage in the stomach, yet these agents significantly aggravated 2DG-induced gastric lesions; the severity of damage was much greater when SC-560 was given together with 2DG. SC-560, but not rofecoxib, enhanced both acid secretion and gastric motility in response to 2DG, with a decrease in mucosal PGE2 content. Expression of COX-2 was up-regulated in the stomach as early as 2 h after 2DG treatment, and the PGE2 content was increased when determined 6 h later, in a COX-2-dependent/rofecoxib-sensitive manner. Both the expression of COX-2 and gastric hypermotility during 2DG treatment were inhibited by prior administration of atropine but not omeprazole, although 2DG-induced gastric lesions were prevented by both agents. Conclusion: These results suggest that potentiation by indomethacin of 2DG-induced gastric lesions is related to inhibition of both COX-1 and COX-2, and that 2DG up-regulates COX-2 in the gastric mucosa, the event occurring in association with gastric hypermotility and contributing to suppression of later extension of the damage.

Induction of intestinal damage by rofecoxib, the selective COX-2 inhibitor, under inhibition of nitric oxide production in rats

We examined whether intestinal damage is provoked in rats under inhibition of both cNOS and COX-2. SC-560, rofecoxib or L-NAME was given either alone or in combination, and the animals were killed 24 h later. Neither SC-560 nor rofecoxib alone provoked damage in the small intestinal mucosa. However, SC-560 produced gross lesions when administered together with rofecoxib. Likewise, L-NAME alone did not cause damage, but this agent provoked gross lesions when administered together with rofecoxib. Mucosal PGE2 content was decreased by SC-560 but not by rofecoxib and L-NAME. The expression of COX-2 was upregulated by L-NAME as well as by SC-560. Both L-NAME and SC-560 enhanced intestinal motility, decreased mucus secretion, and increased the enterobacterial number in the mucosa. We conclude that inhibition of both cNOS and COX-2 provokes intestinal damage. Inhibition of cNOS up-regulates COX-2 expression, and this may be a key to occurrence of intestinal damage associated with COX-2 inhibition.

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.