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(Circulation. 2000;102:840.)
© 2000 American Heart Association, Inc.


Clinical Investigation and Reports

Cyclooxygenase-1 and -2–Dependent Prostacyclin Formation in Patients With Atherosclerosis

Orina Belton, PhD; Dara Byrne, MB; Dermot Kearney, MB; Austin Leahy, MB, MCh; Desmond J. Fitzgerald, MD

From the Departments of Clinical Pharmacology and Surgery, Royal College of Surgeons in Ireland, St Stephens Green, Dublin, Ireland.

Correspondence to Dr Desmond J. Fitzgerald, Department of Clinical Pharmacology, Royal College of Surgeons in Ireland, St Stephens Green, Dublin 2, Ireland. E-mail dfitzgerald{at}rcsi.ie

Background—The formation of prostacyclin (PGI2), thromboxane (TX) A2, and isoprostanes is markedly enhanced in atherosclerosis. We examined the relative contribution of cyclooxygenase (COX)-1 and -2 to the generation of these eicosanoids in patients with atherosclerosis.

Methods and Results—The study population consisted of 42 patients with atherosclerosis who were undergoing surgical revascularization. COX-2 mRNA was detected in areas of atherosclerosis but not in normal blood vessel walls, and there was evidence of COX-1 induction. The use of immunohistochemical studies localized the COX-2 to proliferating vascular smooth muscle cells and macrophages. Twenty-four patients who did not previously receive aspirin were randomized to receive either no treatment or nimesulide at 24 hours before surgery and then for 3 days. Eighteen patients who were receiving aspirin were continued on a protocol of either aspirin alone or a combination of aspirin and nimesulide. Urinary levels of 11-dehydro-TXB2 and 2,3-dinor-6-keto-PGF1{alpha}, metabolites of TXA2 and PGI2, respectively, were elevated in patients with atherosclerosis compared with normal subjects (3211±533 versus 679±63 pg/mg creatinine, P<0.001; 594±156 versus 130±22 pg/mg creatinine, P<0.05, respectively), as was the level of the isoprostane 8-iso-PGF2{alpha}. Nimesulide reduced 2,3-dinor-6-keto-PGF1{alpha} excretion by 46±5% (378.3±103 to 167±37 pg/mg creatinine, P<0.01) preoperatively and blunted the increase after surgery. Nimesulide had no significant effect on 11-dehydro-TXB2 before (2678±694 to 2110±282 pg/mg creatinine) or after surgery. The levels of both products were lower in patients who were taking aspirin, and no further reduction was seen with the addition of nimesulide. None of the treatments influenced urinary 8-iso-PGF2{alpha} excretion.

Conclusions—Both COX-1 and -2 are expressed and contribute to the increase in PGI2 in patients with atherosclerosis, whereas TXA2 is generated by COX-1.


Key Words: atherosclerosis • cyclooxygenase • prostaglandins




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R. Rocha, A. E. Rudolph, G. E. Frierdich, D. A. Nachowiak, B. K. Kekec, E. A. G. Blomme, E. G. McMahon, and J. A. Delyani
Aldosterone induces a vascular inflammatory phenotype in the rat heart
Am J Physiol Heart Circ Physiol, November 1, 2002; 283(5): H1802 - H1810.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
H. Inoue, Y. Taba, Y. Miwa, C. Yokota, M. Miyagi, and T. Sasaguri
Transcriptional and Posttranscriptional Regulation of Cyclooxygenase-2 Expression by Fluid Shear Stress in Vascular Endothelial Cells
Arterioscler Thromb Vasc Biol, September 1, 2002; 22(9): 1415 - 1420.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
R. Bolli, K. Shinmura, X.-L. Tang, E. Kodani, Y.-T. Xuan, Y. Guo, and B. Dawn
Discovery of a new function of cyclooxygenase (COX)-2: COX-2 is a cardioprotective protein that alleviates ischemia/reperfusion injury and mediates the late phase of preconditioning
Cardiovasc Res, August 15, 2002; 55(3): 506 - 519.
[Abstract] [Full Text] [PDF]


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IOVSHome page
S. Sakurai, S. Alam, G. Pagan-Mercado, F. Hickman, J.-Y. Tsai, P. Zelenka, and S. Sato
Retinal Capillary Pericyte Proliferation and c-Fos mRNA Induction by Prostaglandin D2 through the cAMP Response Element
Invest. Ophthalmol. Vis. Sci., August 1, 2002; 43(8): 2774 - 2781.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
G. Block, M. Dietrich, E. P. Norkus, J. D. Morrow, M. Hudes, B. Caan, and L. Packer
Factors Associated with Oxidative Stress in Human Populations
Am. J. Epidemiol., August 1, 2002; 156(3): 274 - 285.
[Abstract] [Full Text] [PDF]


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J. Leukoc. Biol.Home page
J. A. Ardans, A. P. Economou, J. M. Martinson Jr., M. Zhou, and L. M. Wahl
Oxidized low-density and high-density lipoproteins regulate the production of matrix metalloproteinase-1 and -9 by activated monocytes
J. Leukoc. Biol., June 1, 2002; 71(6): 1012 - 1018.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
L. H. Smith, O. Boutaud, M. Breyer, J. D. Morrow, J. A. Oates, and D. E. Vaughan
Cyclooxygenase-2-Dependent Prostacyclin Formation Is Regulated by Low Density Lipoprotein Cholesterol In Vitro
Arterioscler Thromb Vasc Biol, June 1, 2002; 22(6): 983 - 988.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
J. Sadoshima
Novel AT1 Receptor-Independent Functions of Losartan
Circ. Res., April 19, 2002; 90(7): 754 - 756.
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Circ. Res.Home page
C. Kramer, J. Sunkomat, J. Witte, M. Luchtefeld, M. Walden, B. Schmidt, R. H. Boger, W.-G. Forssmann, H. Drexler, and B. Schieffer
Angiotensin II Receptor-Independent Antiinflammatory and Antiaggregatory Properties of Losartan: Role of the Active Metabolite EXP3179
Circ. Res., April 19, 2002; 90(7): 770 - 776.
[Abstract] [Full Text] [PDF]


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J. Biol. Chem.Home page
A. V. Pontsler, A. St. Hilaire, G. K. Marathe, G. A. Zimmerman, and T. M. McIntyre
Cyclooxygenase-2 Is Induced in Monocytes by Peroxisome Proliferator Activated Receptor gamma and Oxidized Alkyl Phospholipids from Oxidized Low Density Lipoprotein
J. Biol. Chem., April 5, 2002; 277(15): 13029 - 13036.
[Abstract] [Full Text] [PDF]


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J. Pharmacol. Exp. Ther.Home page
E. Connolly, D. J. Bouchier-Hayes, E. Kaye, A. Leahy, D. Fitzgerald, and O. Belton
Cyclooxygenase Isozyme Expression and Intimal Hyperplasia in a Rat Model of Balloon Angioplasty
J. Pharmacol. Exp. Ther., February 1, 2002; 300(2): 393 - 398.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
M. Yamada, Y. Numaguchi, K. Okumura, M. Harada, K. Naruse, H. Matsui, T. Ito, and T. Hayakawa
Prostacyclin Synthase Gene Transfer Modulates Cyclooxygenase-2-Derived Prostanoid Synthesis and Inhibits Neointimal Formation in Rat Balloon-Injured Arteries
Arterioscler Thromb Vasc Biol, February 1, 2002; 22(2): 256 - 262.
[Abstract] [Full Text] [PDF]


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Cancer Epidemiol. Biomarkers Prev.Home page
M. Dietrich, G. Block, M. Hudes, J. D. Morrow, E. P. Norkus, M. G. Traber, C. E. Cross, and L. Packer
Antioxidant Supplementation Decreases Lipid Peroxidation Biomarker F2-isoprostanes in Plasma of Smokers
Cancer Epidemiol. Biomarkers Prev., January 1, 2002; 11(1): 7 - 13.
[Abstract] [Full Text]


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CirculationHome page
S. Verma, S. R. Raj, L. Shewchuk, K. J. Mather, and T. J. Anderson
Cyclooxygenase-2 Blockade Does Not Impair Endothelial Vasodilator Function in Healthy Volunteers: Randomized Evaluation of Rofecoxib Versus Naproxen on Endothelium-Dependent Vasodilatation
Circulation, December 11, 2001; 104(24): 2879 - 2882.
[Abstract] [Full Text] [PDF]


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Nephrol Dial TransplantHome page
Z. A. Massy and S. K. Swan
Cyclooxygenase-2 and atherosclerosis: friend or foe?
Nephrol. Dial. Transplant., December 1, 2001; 16(12): 2286 - 2289.
[Full Text] [PDF]


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Circ. Res.Home page
S. T. Davidge
Prostaglandin H Synthase and Vascular Function
Circ. Res., October 12, 2001; 89(8): 650 - 660.
[Abstract] [Full Text] [PDF]


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J. Immunol.Home page
G. E. Caughey, L. G. Cleland, P. S. Penglis, J. R. Gamble, and M. J. James
Roles of Cyclooxygenase (COX)-1 and COX-2 in Prostanoid Production by Human Endothelial Cells: Selective Up-Regulation of Prostacyclin Synthesis by COX-2
J. Immunol., September 1, 2001; 167(5): 2831 - 2838.
[Abstract] [Full Text] [PDF]


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JAMAHome page
D. Mukherjee, S. E. Nissen, and E. J. Topol
Risk of Cardiovascular Events Associated With Selective COX-2 Inhibitors
JAMA, August 22, 2001; 286(8): 954 - 959.
[Abstract] [Full Text] [PDF]


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CirculationHome page
F. Cipollone, C. Prontera, B. Pini, M. Marini, M. Fazia, D. De Cesare, A. Iezzi, S. Ucchino, G. Boccoli, V. Saba, et al.
Overexpression of Functionally Coupled Cyclooxygenase-2 and Prostaglandin E Synthase in Symptomatic Atherosclerotic Plaques as a Basis of Prostaglandin E2-Dependent Plaque Instability
Circulation, August 21, 2001; 104(8): 921 - 927.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
C. Kramer, J. Sunkomat, J. Witte, M. Luchtefeld, M. Walden, B. Schmidt, R. H. Boger, W.-G. Forssmann, H. Drexler, and B. Schieffer
Angiotensin II Receptor-Independent Antiinflammatory and Antiaggregatory Properties of Losartan: Role of the Active Metabolite EXP3179
Circ. Res., April 19, 2002; 90(7): 770 - 776.
[Abstract] [Full Text] [PDF]


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CirculationHome page
J. W. Eikelboom, J. Hirsh, J. I. Weitz, M. Johnston, Q. Yi, and S. Yusuf
Aspirin-Resistant Thromboxane Biosynthesis and the Risk of Myocardial Infarction, Stroke, or Cardiovascular Death in Patients at High Risk for Cardiovascular Events
Circulation, April 9, 2002; 105(14): 1650 - 1655.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. E. Burleigh, V. R. Babaev, J. A. Oates, R. C. Harris, S. Gautam, D. Riendeau, L. J. Marnett, J. D. Morrow, S. Fazio, and M. F. Linton
Cyclooxygenase-2 Promotes Early Atherosclerotic Lesion Formation in LDL Receptor-Deficient Mice
Circulation, April 16, 2002; 105(15): 1816 - 1823.
[Abstract] [Full Text] [PDF]