Cyclooxygenase-1-selective inhibition prolongs gestation in mice without adverse effects on the ductus arteriosus

J Clin Invest. 2002 Aug;110(4):549-57. doi: 10.1172/JCI14924.

Abstract

Preterm delivery is the leading cause of neonatal mortality and contributes significantly to infant morbidity. Classical cyclooxygenase (COX) inhibitors, such as indomethacin, which inhibit both COX-1 and COX-2, are effective for delaying premature labor, but their use is limited by serious complications to the fetus and neonate, including adverse effects on the ductus arteriosus (DA). Using isoform-selective inhibitors, we characterized the roles of the COX isoforms in the initiation of labor and the regulation of fetal and neonatal DA closure in mice. Chronic inhibition of COX-2 during pregnancy (gestation days 15-18) significantly increased neonatal mortality by preventing closure of the DA after birth, whereas acute COX-2 inhibition near the end of term (gestation day 18) constricted the fetal DA. In contrast, the inhibition of COX-1 during pregnancy lacked these prenatal and postnatal adverse effects on the DA and effectively delayed the initiation of full-term labor and LPS-induced preterm labor. These findings suggest that premature fetal DA closure or neonatal patent DA observed following indomethacin tocolysis in women may result from the inhibition of COX-2. Therefore, COX-1-selective inhibitors may provide effective treatment to delay preterm labor with fewer adverse effects on fetal or neonatal health than nonselective or COX-2-selective inhibitors.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Animals, Newborn
  • Constriction, Pathologic / chemically induced
  • Constriction, Pathologic / pathology
  • Cyclooxygenase 1
  • Cyclooxygenase 2
  • Cyclooxygenase 2 Inhibitors
  • Cyclooxygenase Inhibitors / pharmacology*
  • Cyclooxygenase Inhibitors / toxicity
  • Ductus Arteriosus / drug effects*
  • Ductus Arteriosus / pathology
  • Ductus Arteriosus, Patent / chemically induced
  • Ductus Arteriosus, Patent / enzymology
  • Ductus Arteriosus, Patent / pathology
  • Female
  • Fetus / drug effects
  • Fetus / enzymology
  • Gestational Age
  • Isoenzymes / antagonists & inhibitors*
  • Isoenzymes / genetics
  • Kinetics
  • Labor, Obstetric / drug effects*
  • Maternal-Fetal Exchange
  • Membrane Proteins
  • Mice
  • Mice, Inbred C57BL
  • Mice, Knockout
  • Pregnancy
  • Pregnancy, Animal / drug effects*
  • Prostaglandin-Endoperoxide Synthases / genetics
  • Pyrazoles / pharmacology*
  • Pyrazoles / toxicity
  • Receptors, Thromboxane / agonists
  • Survival Analysis

Substances

  • Cyclooxygenase 2 Inhibitors
  • Cyclooxygenase Inhibitors
  • Isoenzymes
  • Membrane Proteins
  • Pyrazoles
  • Receptors, Thromboxane
  • SC 560
  • Cyclooxygenase 1
  • Cyclooxygenase 2
  • Prostaglandin-Endoperoxide Synthases
  • Ptgs1 protein, mouse