Prostaglandin-endoperoxide synthase 2 (prostaglandin G/H synthase and cyclooxygenase) (The
HUGO official symbol is PTGS2; HGNC ID, HGNC:9605), also known as cyclooxygenase-2 or COX-2, is an
enzyme
Enzymes () are proteins that act as biological catalysts by accelerating chemical reactions. The molecules upon which enzymes may act are called substrate (chemistry), substrates, and the enzyme converts the substrates into different molecule ...
that in humans is encoded by the ''PTGS2''
gene
In biology, the word gene (from , ; "... Wilhelm Johannsen coined the word gene to describe the Mendelian units of heredity..." meaning ''generation'' or ''birth'' or ''gender'') can have several different meanings. The Mendelian gene is a b ...
.
In humans it is one of two
cyclooxygenases. It is involved in the conversion of
arachidonic acid to
prostaglandin H2, an important precursor of
prostacyclin, which is expressed in
inflammation
Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...
.
Function
PTGS2 (COX-2), converts
arachidonic acid (AA) to prostaglandin endoperoxide H2. PTGSs are targets for
NSAIDs and PTGS2 (COX-2) specific inhibitors called coxibs. PTGS-2 is a sequence homodimer. Each
monomer of the enzyme has a
peroxidase and a PTGS (COX)
active site. The PTGS (COX) enzymes catalyze the conversion of
arachidonic acid to
prostaglandins in two steps. First, hydrogen is abstracted from carbon 13 of arachidonic acid, and then two molecules of oxygen are added by the PTGS2 (COX-2), giving PGG2. Second,
PGG2 is reduced to
PGH2 in the peroxidase active site. The synthesized PGH2 is converted to prostaglandins (
PGD2,
PGE2,
PGF2α),
prostacyclin (PGI2), or
thromboxane A2 by tissue-specific isomerases.(Figure 2)
While metabolizing arachidonic acid primarily to PGG2, COX-2 also converts this fatty acid to small amounts of a racemic mixture of
15-Hydroxyicosatetraenoic acid
15-Hydroxyeicosatetraenoic acid (also termed 15-HETE, 15(''S'')-HETE, and 15''S''-HETE) is an eicosanoid, i.e. a metabolite of arachidonic acid. Various cell types metabolize arachidonic acid to 15(''S'')-hydroperoxyeicosatetraenoic acid (15(''S' ...
s (i.e., 15-HETEs) composed of ~22% 15(''R'')-HETE and ~78% 15(''S'')-HETE
stereoisomers as well as a small amount of 11(''R'')-HETE.
The two 15-HETE stereoisomers have intrinsic biological activities but, perhaps more importantly, can be further metabolized to a major class of agents, the
lipoxins. Furthermore,
aspirin-treated COX-2 metabolizes arachidonic acid almost exclusively to 15(''R'')-HETE which product can be further metabolized to epi-
lipoxins.
The lipoxins and epi-lipoxins are potent anti-inflammatory agents and may contribute to the overall activities of the two COX's as well as to aspirin.
COX-2 is naturally inhibited by
calcitriol (the active form of Vitamin D).
Mechanism

Both the peroxidase and PTGS activities are inactivated during catalysis by mechanism-based, first-order processes, which means that PGHS-2 peroxidase or PTGS activities fall to zero within 1–2 minutes, even in the presence of sufficient substrates.
The conversion of arachidonic acid to PGG2 can be shown as a series of
radical reactions analogous to polyunsaturated
fatty acid
In chemistry, particularly in biochemistry, a fatty acid is a carboxylic acid with an aliphatic chain, which is either saturated or unsaturated. Most naturally occurring fatty acids have an unbranched chain of an even number of carbon atoms, ...
autoxidation.
The 13-pro(S) -hydrogen is abstracted and dioxygen traps the
pentadienyl radical at carbon 11. The 11-peroxyl radical cyclizes at carbon 9 and the carbon-centered radical generated at C-8 cyclizes at carbon 12, generating the
endoperoxide. The
allylic radical generated is trapped by dioxygen at carbon 15 to form the 15-(S) -peroxyl radical; this radical is then reduced to
PGG2 . This is supported by the following evidence: 1) a significant
kinetic isotope effect is observed for the abstraction of the 13-pro (S )-hydrogen; 2) carbon-centered radicals are trapped during
catalysis;
3) small amounts of
oxidation
Redox (reduction–oxidation, , ) is a type of chemical reaction in which the oxidation states of substrate change. Oxidation is the loss of electrons or an increase in the oxidation state, while reduction is the gain of electrons or a ...
products are formed due to the oxygen trapping of an allylic radical intermediate at positions 13 and 15.
Another mechanism in which the 13-pro (S )-hydrogen is
deprotonated and the
carbanion is
oxidized to a
radical is theoretically possible. However, oxygenation of 10,10-difluoroarachidonic acid to 11-(S )-hydroxyeicosa-5,8,12,14-tetraenoic acid is not consistent with the generation of a carbanion intermediate because it would eliminate fluoride to form a conjugated diene.
The absence of endoperoxide-containing products derived from 10,10-difluoroarachidonic acid has been thought to indicate the importance of a C-10 carbocation in
PGG2 synthesis.
However, the cationic mechanism requires that endoperoxide formation comes before the removal of the 13-pro (S )-hydrogen. This is not consistent with the results of the isotope experiments of
arachidonic acid oxygenation.
Structure
PTGS2 (COX-2) exists as a homodimer, each monomer with a molecular mass of about 70 kDa. The tertiary and quaternary structures of PTGS1 (COX-1) and PTGS2 (COX-2) enzymes are almost identical. Each subunit has three different structural domains: a short
N-terminal epidermal growth factor (
EGF EGF may refer to:
* E.G.F., a Gabonese company
* East Grand Forks, Minnesota, a city
* East Garforth railway station in England
* Epidermal growth factor
* Equity Group Foundation, a Kenyan charity
* European Gendarmerie Force, a military unit of ...
) domain; an
α-helical membrane-binding moiety; and a
C-terminal
The C-terminus (also known as the carboxyl-terminus, carboxy-terminus, C-terminal tail, C-terminal end, or COOH-terminus) is the end of an amino acid chain (protein or polypeptide), terminated by a free carboxyl group (-COOH). When the protein is ...
catalytic domain. PTGS (COX, which can be confused with "
cytochrome oxidase") enzymes are
monotopic membrane proteins; the membrane-binding domain consists of a series of
amphipathic α helices with several
hydrophobic amino acids exposed to a membrane monolayer. PTGS1 (COX-1) and PTGS2 (COX-2) are bifunctional enzymes that carry out two consecutive chemical reactions in spatially distinct but mechanistically
coupled active sites. Both the
cyclooxygenase and the
peroxidase active sites are located in the catalytic domain, which accounts for approximately 80% of the protein. The catalytic domain is
homologous
Homology may refer to:
Sciences
Biology
*Homology (biology), any characteristic of biological organisms that is derived from a common ancestor
*Sequence homology, biological homology between DNA, RNA, or protein sequences
* Homologous chrom ...
to mammalian peroxidases such as
myeloperoxidase.
It has been found that human PTGS2 (COX-2) functions as a conformational heterodimer having a catalytic monomer (E-cat) and an allosteric monomer (E-allo).
Heme binds only to the
peroxidase site of E-cat while substrates, as well as certain
inhibitors (e.g.
celecoxib
Celecoxib, sold under the brand name Celebrex among others, is a COX-2 inhibitor and nonsteroidal anti-inflammatory drug (NSAID). It is used to treat the pain and inflammation in osteoarthritis, acute pain in adults, rheumatoid arthritis, ...
), bind the COX site of E-cat. E-cat is regulated by E-allo in a way dependent on what ligand is bound to E-allo.
Substrate
Substrate may refer to:
Physical layers
*Substrate (biology), the natural environment in which an organism lives, or the surface or medium on which an organism grows or is attached
** Substrate (locomotion), the surface over which an organism lo ...
and non-substrate
fatty acid
In chemistry, particularly in biochemistry, a fatty acid is a carboxylic acid with an aliphatic chain, which is either saturated or unsaturated. Most naturally occurring fatty acids have an unbranched chain of an even number of carbon atoms, ...
(FAs) and some PTGS (COX) inhibitors (e.g.
naproxen) preferentially bind to the PTGS (COX) site of E-allo.
Arachidonic acid can bind to E-cat and E-allo, but the affinity of AA for E-allo is 25 times that for Ecat. Palmitic acid, an efficacious stimulator of
huPGHS-2, binds only E-allo in palmitic acid/murine PGHS-2 co-crystals. Non-substrate FAs can potentiate or
attenuate PTGS (COX) inhibitors depending on the
fatty acid
In chemistry, particularly in biochemistry, a fatty acid is a carboxylic acid with an aliphatic chain, which is either saturated or unsaturated. Most naturally occurring fatty acids have an unbranched chain of an even number of carbon atoms, ...
and whether the inhibitor binds E-cat or E-allo. Studies suggest that the concentration and composition of the free fatty acid pool in the environment in which PGHS-2 functions in cells, also referred to as the FA tone, is a key factor regulating the activity of PGHS-2 and its response to PTGS (COX) inhibitors.
Clinical significance

PTGS2 (COX-2) is unexpressed under normal conditions in most cells, but elevated levels are found during
inflammation
Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving im ...
. PTGS1 (COX-1) is constitutively expressed in many tissues and is the predominant form in gastric mucosa and in the kidneys. Inhibition of PTGS1 (COX-1) reduces the
basal production
Basal or basilar is a term meaning ''base'', ''bottom'', or ''minimum''.
Science
* Basal (anatomy), an anatomical term of location for features associated with the base of an organism or structure
* Basal (medicine), a minimal level that is nece ...
of cytoprotective
PGE2 and
PGI2 in the
stomach, which may contribute to
gastric ulceration. Since PTGS2 (COX-2) is generally expressed only in cells where
prostaglandins are upregulated (e.g., during inflammation), drug-candidates that selectively inhibit PTGS2 (COX-2) were suspected to show fewer
side-effects
In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequence ...
but proved to substantially increase risk for cardiovascular events such as heart attack and stroke. Two different mechanisms may explain contradictory effects. Low-dose aspirin protects against heart attacks and strokes by blocking PTGS1 (COX-1) from forming a prostaglandin called thromboxane A2. It sticks platelets together and promotes clotting; inhibiting this helps prevent heart disease. On the other hand, PTGS2 (COX-2) is a more important source of prostaglandins, particularly prostacyclin which is found in blood vessel lining. Prostacyclin relaxes or unsticks platelets, so
selective COX-2 inhibitors (coxibs) increase risk of cardiovascular events due to clotting.
Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit
prostaglandin production by PTGS1 (COX-1) and PTGS2 (COX-2).
NSAIDs selective for inhibition of PTGS2 (COX-2) are less likely than traditional drugs to cause
gastrointestinal adverse effects, but could cause
cardiovascular events, such as
heart failure,
myocardial infarction
A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which ...
, and
stroke
Stroke (also known as a cerebrovascular accident (CVA) or brain attack) is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic ...
. Studies with human
pharmacology and
genetics
Genetics is the study of genes, genetic variation, and heredity in organisms.Hartl D, Jones E (2005) It is an important branch in biology because heredity is vital to organisms' evolution. Gregor Mendel, a Moravian Augustinian friar worki ...
, genetically manipulated
rodents, and other animal models and randomized trials indicate that this is due to suppression of PTGS2 (COX-2)-dependent cardioprotective
prostaglandins,
prostacyclin in particular.
The expression of PTGS2 (COX-2) is upregulated in many cancers. The overexpression of PTGS2 (COX-2) along with increased angiogenesis and SLC2A1 (GLUT-1) expression is significantly associated with gallbladder carcinomas.
Furthermore, the product of PTGS2 (COX-2),
PGH2 is converted by
prostaglandin E2 synthase into
PGE2, which in turn can stimulate cancer progression. Consequently, inhibiting PTGS2 (COX-2) may have benefit in the prevention and treatment of these types of cancer.
COX-2 expression was found in human idiopathic epiretinal membranes. Cyclooxygenases blocking by
lornoxicam in acute stage of inflammation reduced the frequency of membrane formation by 43% in the
dispase Dispase is a protease which cleaves fibronectin, collagen IV, and to a lesser extent collagen I. It is found in some bacteria and can be isolated from culture filtrates of ''Bacillus polymyxa''. It can be extracted, purified, and used in research. I ...
model of
PVR and by 31% in the
concanavalin one.
Lornoxicam not only normalized the expression of cyclooxygenases in both models of PVR, but also neutralized the changes of the
retina and the
choroid thickness caused by the injection of pro-inflammatory agents. These facts underline the importance of cyclooxygenases and prostaglandins in the development of PVR.
PTGS2 gene upregulation has also been linked with multiple stages of human reproduction. Presence of gene is found in the
chorionic plate, in the
amnion epithelium,
syncytiotrophoblasts, villous fibroblasts, chorionic
trophoblasts,
amniotic trophoblasts, as well as the
basal plate of the placenta, in the
decidual cells
Before the fertilized ovum reaches the uterus, the mucous membrane of the body of the uterus undergoes important changes and is then known as the decidua. The thickness and vascularity of the mucous membrane are greatly increased; its glands are el ...
and
extravillous cytotrophoblasts. During the process of
chorioamnionitis
Chorioamnionitis, also known as intra-amniotic infection (IAI), is inflammation of the fetal membranes (amnion and chorion), usually due to bacterial infection. In 2015, a National Institute of Child Health and Human Development Workshop expert p ...
/deciduitis, the upregulation of PTGS2 in the
amnion and choriodecidua is one of three limited effects of inflammation in the
uterus
The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The ...
. Increased expression of the PTGS2 gene in the
fetal membranes is connected to the presence of inflammation, causing uterine prostaglandin gene expression and immunolocalization of
prostaglandin pathway proteins in chorionic trophoblast cells and adjacent decidua, or choriodecidua. PTGS2 is linked with the inflammatory system and has been observed in inflammatory
leukocytes. It has been noted that there is a positive correlation with PTGS2 expression in the amnion during spontaneous labour and was discovered to have increased expression with gestational age following the presence of labour with no change observed in amnion and choriodecidua during either preterm or term labour. Additionally,
oxytocin stimulates the expression of PTGS2 in
myometrial cells.
[Phillips, Robert J et al. “Prostaglandin pathway gene expression in human placenta, amnion and choriodecidua is differentially affected by preterm and term labour and by uterine inflammation.” BMC pregnancy and childbirth vol. 14 241. 22 Jul. 2014, doi:10.1186/1471-2393-14-241]
The mutant allele PTGS2 5939C carriers among the Han Chinese population have been shown to have a higher risk of
gastric cancer. In addition, a connection was found between ''
Helicobacter pylori'' infection and the presence of the 5939C allele.
Interactions
PTGS2 has been shown to
interact with
caveolin 1.
History
PTGS2 (COX-2) was discovered in 1991 by the
Daniel Simmons laboratory
at Brigham Young University.
See also
*
Arachidonic acid
*
Cyclooxygenase
*
Cyclooxygenase 1
*
NSAID
*
Discovery and development of COX-2 selective inhibitors
*
COX-2 selective inhibitor
References
Further reading
*
*
*
*
*
*
*
*
*
*
*
*
External links
NextbioNSAIDs and Cardiovascular Risk Explained, According to Studies from the Perelman School of Medicine*
{{Prostanoidergics
Prostaglandins