LIMA, Marcos Antonio Pereira de. Carcinoma de células escamosas oral: relevância do Papiloma vírus humano (HPV) e do vírus Epstein-Barr (EBV) na expressão de proteinas p16INK4a, E-caderina, COX-2, MLH1, p53 e MYC. 2013. 180 f. : Tese (doudorado) - Universidade Federal do Ceará, Programa de Pós-Graduação em Biotecnologia, Rede Nordestes de Biotecnologia -Renorbio, Fortaleza-CE, 2013. / Submitted by demia Maia (demiamlm@gmail.com) on 2016-05-27T13:30:28Z No. of bitstreams: 1 2013_tese_maplima.pdf: 16584856 bytes, checksum: 9b25880d41a42f87ebcd6222528b072e (MD5) / Approved for entry into archive by demia Maia (demiamlm@gmail.com) on 2016-05-27T13:30:59Z (GMT) No. of bitstreams: 1 2013_tese_maplima.pdf: 16584856 bytes, checksum: 9b25880d41a42f87ebcd6222528b072e (MD5) / Made available in DSpace on 2016-05-27T13:30:59Z (GMT). No. of bitstreams: 1 2013_tese_maplima.pdf: 16584856 bytes, checksum: 9b25880d41a42f87ebcd6222528b072e (MD5) Previous issue date: 2013 / The oral cancer represents a serious world public health problem. The oral squamous cell carcinomas (OSCC) account for up to 94% of the tumors of this anatomic site. The molecular mechanisms involved in the genesis and progression are still not well elucidated. Some evidences have suggested the involvement of viruses in this process. Also, these tumors still lack of reliable markers to determine the aggressiveness profile. In this context, the aim of the present study was to evaluate the expression of the proteins p53, E-cadherin, COX-2, p16, MLH1 and MYC in a serie of OSCC, including the cytoplasmic staining eventually observed for the latter three proteins, confronting the results between them and with demographic and clinico-pathological features. Besides evaluating the prevalence of Human Papillomavirus (HPV) and Epstein-Barr virus (EBV) in the sample and compare them with the expression of the referred proteins. Materials and Methods – One hundred formalin-fixed paraffin-embedded OSCC specimens were submitted to immunohistochemistry for detection of the referred proteins, and to in situ hybridization for HPV and EBV detection. Results – OSCC was associated with a concomitant lack of expression of p16 and MLH1 (p=0.029) and coexpression of p53 and COX-2 (p=0.045). Additionally, COX-2 and nuclear MYC were found to be related to exclusively cytoplasmic staining of MLH1 (p=0.060 and p=0.018, respectively). The combination analyses of the markers revealed five main groups of altered protein expression, which were mostly of the more aggressive tumors, mainly the MLH1(-)/COX-2(+)/p16(-) group. The cases with cytoplasmic staining for p16, MLH1 and/or MYC were more frequent in advanced tumors (p=0.009) and in those with lymph node metastasis (p=0.001). Thirty-one cases showed staining for HPV in tumor tissue. The EBV was not detected in any case investigated, neither in the tumor tissue nor in the non-neoplastic epithelium. The HPV(+) group demonstrated high positivity for nuclear p16 (p=0,029) and cytoplasmic MYC (p=0,039), and an increase of the lack of MLH1 nuclear expression (p=0,031). There was also a trend related to the increase of the COX-2 positivity in the HPV(+) group (p=0,084). Conclusions – The significance between p16 and MLH1 suggests that the lack of this member of mismatch repair system also favors the occurrence of mutations in the p16 gene, culminating in inactivation of this tumor suppressor. The associations of COX-2 and MYC with cytoplasmic MLH1 suggest a blocking mechanism for the entry of MLH1 into the nucleus. The combined analyses of the proteins investigated, as well as the cytoplasmic staining of p16, MLH1 and MYC, may be useful in the evaluation of the aggressive profile and probably prognosis of OSCC. Regarding the viruses, our findings suggest that the HPV is involved in an important portion of OSCC cases and that may promote the expression of the nuclear p16, cytoplasmic MYC and COX-2, and suppress the nuclear expression of MLH1. About EBV, it was not detected the EBV-encoded small RNAs (EBERs) in the sample. / O câncer oral representa um sério problema de saúde pública mundial. Entre os tumores deste sítio anatômico, os carcinomas de células escamosas orais (CCEO) respondem por até 94% do total. Os mecanismos moleculares envolvidos na gênese e desenvolvimento tumoral ainda não estão completamente elucidados. Algumas evidências têm sugerido a participação viral neste processo. Além disso, estes tumores ainda carecem de marcadores confiáveis para determinar o perfil de agressividade. Neste contexto, o presente estudo teve como objetivo avaliar a expressão das proteínas p53, E-caderina, COX-2, p16, MLH1 e MYC numa série de CCEO, considerando também a marcação citoplasmática eventualmente observada para as últimas três proteínas, confrontando os resultados entre elas e com as características demográficas e clínico-patológicas. Além de avaliar a prevalência do Papilomavírus Humano (HPV) e do Vírus Epstein-Barr (EBV) na amostra e compará-las com a expressão das referidas proteínas. Materiais e Métodos – Cem espécimes de CCEO, fixados em formalina e incluídos em blocos de parafina, foram submetidos à imunohistoquímica para a detecção das referidas proteínas e à hibridação in situ para detecaçõ de HPV e EBV. Resultados – Foi observada associação referente à perda de expressão concomitante de p16 e MLH1 (p=0,029) e na coexpressão de p53 e COX-2 (p=0,045). Ademais, foi verificado que a COX-2 e o MYC nuclear estavam relacionados com a marcação citoplasmática de MLH1 (p=0,060 e p=0,018; respectivamente). A análise combinada dos marcadores revelou cinco grupos principais de expressão alterada que eram constituídos, em sua maioria, de tumores mais agressivos, principalmente o grupo MLH1(-)/COX-2(+)/p16(-). Os casos com marcação citoplasmática para p16, MLH1 e/ou MYC foram mais frequentes em tumores avançados (p=0,009) e naqueles com metástases em linfonodos (p=0,001). Trinta e um casos demonstraram marcação para HPV em tecido tumoral. O EBV não foi detectado em nenhum dos casos investigados, nem no tecido tumoral nem no epitélio não neoplásico. O grupo HPV(+) exibiu elevada positividade para o p16 nuclear (p=0,029) e MYC cytoplasmático (p=0,039), também uma maior perda de expressão nuclear de MLH1 (p=0,031). Houve ainda uma tendência referente ao aumento da positividade de COX-2 no grupo infectado (p=0,084). Conclusões – As significâncias verificadas entre p16 e MLH1 sugerem que a ausência do membro do sistema de reparo de encaixe (MMR) também favoreça a ocorrência de mutações no gene p16, culminando na inativação deste supressor tumoral. As associações de COX-2 e MYC com o MLH1 de expressão citoplasmática suscitam um mecanismo de bloqueio de entrada de MLH1 no núcleo. A análise combinada das proteínas, bem como, a marcação citoplasmática de p16, MLH1 e MYC, podem representar indicadores úteis na avaliação do perfil de agressividade e, provavelmente, de prognóstico em CCEO. Acerca dos vírus, nossos achados sugerem que o HPV esteja envolvido em uma importante parcela de casos de CCEO e que possa promover a expressão de p16 nuclear, MYC citoplasmático e COX-2, e suprimir a expressão nuclear de MLH1. Quanto ao EBV, não foram detectados EBERs (EBV-encoded small RNAs) na amostra.

Made available in DSpace on 2016-08-17T18:39:42Z (GMT). No. of bitstreams: 1 4298.pdf: 15812505 bytes, checksum: 0d001ab7407810f069373f198494cc0f (MD5) Previous issue date: 2011-12-14 / Prostaglandin H synthases (PGHS), or cyclooxygenases (COX), are known to exist in at least two isoforms, COX-1 and COX-2, encoded by different genes. COX s play a central role in the inflammatory cascade by converting arachidonic acid, released from membrane phospholipids, into bioactive prostanoids. Non-steriodal anti-inflammatory drugs (NSAIDs) represent an important therapeutic category related to the reduction of inflammation, pain and fever, however, can cause gastric and kidney failure. Selective inhibition of COX-2 by NSAIDs known as coxibs leads to a significant reduction of these side effects in addition reduce fatal thrombotic events and act in controlling some types of cancer and progression of Alzheimer's disease, when used for a long period. This study, based on molecular docking, describes the search for the most favorable poses in the formation of complexes between COX-2 and resveratrol analogues and 1,2,3-triazole derivatives. The three dimensional structure of the enzyme, 1cx2, was obtained from the Protein Data Bank (PDB). The structures of the ligands were obtained by molecular modeling. The docking calculations were carried out with the program GOLD 4.1.2. Analyses of the docking results show that interactions with residues of the side pocket of COX are important for the stabilization of the complexes, in particular His90, Arg120, Ser353, Tyr355 and Arg513 should be mentioned. The ligands studied locate, preferably, between α-helices 13 and 26 of the isoenzyme, and the interaction with the serine 353 residue seems to be related to the activity presented by ligands with low IC50 values, a characteristics that can be exploited in rational design of new leader molecules or in the optimization of selective ligands that should occupy the side pocket of the cyclooxygenase active site of COX-2. / Prostaglandinas H sintases (PGHS), ou ciclooxigenases (COX), existem em pelo menos duas isoformas, COX-1 e COX-2, codificadas por genes diferentes. A COX desempenha um papel central no processo inflamatório através da conversão do ácido araquidônico, liberado a partir dos fosfolipídios da membrana, em prostanóides bioativos. Anti-inflamatórios não esteroides (AINEs) representam uma importante categoria terapêutica relacionada à redução de inflamação, dor, e febre, no entanto, podem causar insuficiência renal e gástrica. A inibição seletiva da COX-2 pelos AINEs conhecidos como coxibs leva a uma redução significativa desses efeitos colaterais, além de reduzir eventos trombóticos fatais e agir no controle de alguns tipos de câncer e na progressão do mal de Alzheimer, quando utilizados de forma prolongada. Este estudo, baseado em docking molecular, descreve a busca das poses mais favoráveis para a formação dos complexos entre a COX-2 e ligantes análogos do resveratrol e derivados de 1,2,3-triazol. A estrutura tridimensional da enzima 1cx2 foi obtida do Protein Data Bank (PDB). As estruturas dos ligantes foram obtidas por modelagem molecular. Os cálculos de docking foram realizados utilizando o programa GOLD 4.1.2. As análises dos resultados de docking mostram que as interações com os resíduos do bolso lateral presente na COX são importantes para a estabilização dos complexos, especialmente, His90, Arg120, Ser353, Tyr355 e Arg513. Os ligantes estudados se localizam, preferencialmente, entre as α- hélices 13 e 26 da isoenzima, sendo que a interação com o resíduo serina 353 demonstra estar relacionada com a atividade apresentada por ligantes com baixos valores de IC50, característica que pode ser explorada racionalmente no desenho de novas moléculas lideres ou na otimização de ligantes seletivos que ocupem o bolso lateral do sítio ativo ciclooxigenase da COX-2.

Submitted by ALEXANDRE BORGES null (alex.brgs@hotmail.com) on 2016-06-28T19:11:21Z No. of bitstreams: 1 ESTUDOS DE MODELAGEM MOLECULAR DE LIGNANAS EM COMPLEXOS COM CICLOOXIGENASES-1 E 2.pdf: 4325586 bytes, checksum: 2f6ab56677aea7746bd28dad4b24ea23 (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-06-29T17:41:12Z (GMT) No. of bitstreams: 1 borges_a_dr_ilha.pdf: 4325586 bytes, checksum: 2f6ab56677aea7746bd28dad4b24ea23 (MD5) / Made available in DSpace on 2016-06-29T17:41:12Z (GMT). No. of bitstreams: 1 borges_a_dr_ilha.pdf: 4325586 bytes, checksum: 2f6ab56677aea7746bd28dad4b24ea23 (MD5) Previous issue date: 2016-05-11 / Os inibidores seletivos da ciclooxigenase-2 (COX-2), como o rofecoxibe (2) e o celecoxibe (1), formam uma importante classe de medicamentos anti-inflamatórios desenvolvidos a partir da descoberta das duas isoformas das ciclooxigenases (COX-1 e COX-2) na década de 1979. A isoforma 1 esta relacionada com a citoproteção gástrica, agregação plaquetária e função renal e a isoforma 2 relacionada a processos inflamatórios. Estes inibidores seletivos apesar de não apresentarem os efeitos colaterais (ulceras e gastrites) dos anti-inflamatórios não esteroidais (AINEs) clássicos por inibirem apenas a COX-2, apresentam grave risco cardiovascular, o que motivou à retirada do rofecoxibe do mercado. Porém, por ser um eficiente inibidor seletivo da COX-2 a estrutura do rofecoxibe tornou-se referência no estudo de novas substâncias capazes de inibir seletivamente a COX-2. Dentre as ferramentas utilizadas na busca destas novas estruturas está a modelagem molecular através de programas como o GOLD 5.1, que foi utilizado neste trabalho. O uso do GOLD 5.1 possibilitou o estudo do comportamento das estruturas avaliadas em ligação com as ciclooxigenases. O objetivo foi obtenção de estruturas com comportamento semelhante ao rofecoxibe (em relação às COXs) como potenciais candidatos ao desenvolvimento de novos inibidores seletivos para a COX-2. O estudo foi realizado com 480 estruturas modeladas a partir de lignanas naturais como a hinoquinina, cubebina, deoxipodofilotoxina e podofilotoxina, que apresentam atividade anti-inflamatória in vivo ou in vitro, além de semelhanças estruturais com o rofecoxibe. A deoxipodofilotoxina por apresentar seletividade para a COX-2 em ensaio in vitro também foi utilizada como estrutura de referência além do rofecoxibe. Os resultados observados a partir da simulação molecular permitiram concluir que embora tanto o rofecoxibe como a deoxipodofilotoxina (3) inibam seletivamente a COX-2 in vitro, o fazem de modo diferente. Em relação a COX-2 as duas estruturas ocupam a mesma região do sítio ativo, mas o rofecoxibe apresenta interações mais fortes com o bolso hidrofílico desta isoforma (condição necessária para a inibição seletiva para os coxibes). Já para a COX-1 enquanto o rofecoxibe ocupa a porção superior do canal hidrofóbico (sítio ativo) como os demais AINEs, a deoxipodofilotoxina ocupa uma região vizinha. Pelos resultados obtidos é possível sugerir que tanto a maior flexibilidade das estruturas como a presença do anel lactônico, são importantes para um comportamento análogo ao rofecoxibe ou à deoxipodofilotoxina. Com relação à interação com o bolso hidrofílico da COX-2, os resultados sugerem que a presença de grupos aceptores de prótons menos volumosos nas posições C3 e C4, C3’ e C4’ ou C4 levam a resultados melhores que grupos aceptores de maior volume. A presença de grupos doadores de prótons apesar de permitirem forte interação com o bolso hidrofílico da COX-2 leva a resultados globais insatisfatórios, pois formam interações fortes com o resíduo Arg120 do sítio ativo da COX-1, interação considerada importante para a inibição não seletiva. Resultado semelhante à deoxipodofilotoxina foi observado apenas para a estrutura 17. As estruturas 37, 188, 266, 267, 348 e a hinoquinina (4) apresentam resultados semelhantes ao rofecoxibe, para as duas isoformas. Deste modo permite-se sugerir a partir dos resultados obtidos neste estudo que a hinoquinina (4) e as estruturas 17, 37, 188, 266, 267 e 348 apresentam-se como possíveis protótipos de fármacos que atuem como inibidores seletivos para a COX-2. / The selective inhibitors of the cyclooxygenase-2 (COX-2) as rofecoxib (2) and celecoxib (1), form an important class of anti-inflammatory drugs developed from the discovery of two isoforms of cyclooxygenases (COX-1 and COX-2) in the late 1979. Isoform 1 is related to the gastric cytoprotection, platelet and renal function and isoform 2 related to inflammatory processes. These selective inhibitors although they did not side effects (ulcers and gastritis) of the classic NSAIDs to inhibit only COX-2, have severe cardiovascular risk, which led to the withdrawal of rofecoxib from the market. However, to be an effective selective COX-2 to rofecoxib structure has a reference in the study of new substances capable of selectively inhibiting COX-2. Among the tools used in the search of these new structures is by molecular modeling program such as GOLD 5.1, which was used in this work. Using GOLD 5.1 made it possible to study the behavior of structures evaluated in binding with the cyclooxygenases. With the objective of obtaining structures with similar behavior to rofecoxib (regarding behavior with COX) as potential candidates for the development of new selective inhibitors for COX-2. The study was conducted with 480 structures modeled from natural lignans as hinokinin, cubebin, deoxypodophyllotoxin and podophyllotoxin, which have anti-inflammatory activity in vivo or in vitro as well as structural similarities with rofecoxib. The deoxypodophyllotoxin for presenting selectivity for COX-2 in the in vitro assay was also used as a reference structure beyond rofecoxib. The results observed from the molecular simulation showed that although both rofecoxib (2) as deoxypodophyllotoxin (3) selectively inhibit COX-2 in vitro, they do differently. In relation to COX-2 the two structures occupy the same region of the active site, but rofecoxib has stronger interactions with the hydrophilic pocket of this isoform (a necessary condition for the selective inhibition for coxibs). As for the COX-1 while rofecoxib occupies the upper portion of the hydrophobic channel (active site) like other NSAIDs, the deoxypodophyllotoxin occupies a neighboring region. From the results it is possible to suggest that the greater flexibility of the structures such as the presence of the lactone ring, are important for a similar behavior to rofecoxib or deoxipodofilotoxina. With respect to the interaction with the hydrophilic pocket COX-2, the results suggest that the presence of acceptors groups less bulky protons in posítions C3 and C4, C3 ' and C4' and C4 lead to better results than acceptors groups of larger volume. The presence of proton donors groups despite allowing strong interaction with the hydrophilic pocket COX-2 lead to poor overall results, since they form strong interactions with Arg120 residue of COX-1 active site, considered important interaction for inhibiting non-selective. Results similar to deoxipodofilotoxina was only observed for structure 17. Structures 37, 188, 266, 267, 348 and hinokinin (4) show results similar to rofecoxib for the two isoforSA. Thus it allows suggest from the results obtained in this study hinokinin (4) and structures 17, 37, 188, 266, 267 and 348 are shown as possible prototype drugs that act as selective inhibitors for COX-2.

Orientador: Rosangela da Silva de Laurentiz / Resumo: Os inibidores seletivos da ciclooxigenase-2 (COX-2), como o rofecoxibe (2) e o celecoxibe (1), formam uma importante classe de medicamentos anti-inflamatórios desenvolvidos a partir da descoberta das duas isoformas das ciclooxigenases (COX-1 e COX-2) na década de 1979. A isoforma 1 esta relacionada com a citoproteção gástrica, agregação plaquetária e função renal e a isoforma 2 relacionada a processos inflamatórios. Estes inibidores seletivos apesar de não apresentarem os efeitos colaterais (ulceras e gastrites) dos anti-inflamatórios não esteroidais (AINEs) clássicos por inibirem apenas a COX-2, apresentam grave risco cardiovascular, o que motivou à retirada do rofecoxibe do mercado. Porém, por ser um eficiente inibidor seletivo da COX-2 a estrutura do rofecoxibe tornou-se referência no estudo de novas substâncias capazes de inibir seletivamente a COX-2. Dentre as ferramentas utilizadas na busca destas novas estruturas está a modelagem molecular através de programas como o GOLD 5.1, que foi utilizado neste trabalho. O uso do GOLD 5.1 possibilitou o estudo do comportamento das estruturas avaliadas em ligação com as ciclooxigenases. O objetivo foi obtenção de estruturas com comportamento semelhante ao rofecoxibe (em relação às COXs) como potenciais candidatos ao desenvolvimento de novos inibidores seletivos para a COX-2. O estudo foi realizado com 480 estruturas modeladas a partir de lignanas naturais como a hinoquinina, cubebina, deoxipodofilotoxina e podofilotoxina, que apre... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The selective inhibitors of the cyclooxygenase-2 (COX-2) as rofecoxib (2) and celecoxib (1), form an important class of anti-inflammatory drugs developed from the discovery of two isoforms of cyclooxygenases (COX-1 and COX-2) in the late 1979. Isoform 1 is related to the gastric cytoprotection, platelet and renal function and isoform 2 related to inflammatory processes. These selective inhibitors although they did not side effects (ulcers and gastritis) of the classic NSAIDs to inhibit only COX-2, have severe cardiovascular risk, which led to the withdrawal of rofecoxib from the market. However, to be an effective selective COX-2 to rofecoxib structure has a reference in the study of new substances capable of selectively inhibiting COX-2. Among the tools used in the search of these new structures is by molecular modeling program such as GOLD 5.1, which was used in this work. Using GOLD 5.1 made it possible to study the behavior of structures evaluated in binding with the cyclooxygenases. With the objective of obtaining structures with similar behavior to rofecoxib (regarding behavior with COX) as potential candidates for the development of new selective inhibitors for COX-2. The study was conducted with 480 structures modeled from natural lignans as hinokinin, cubebin, deoxypodophyllotoxin and podophyllotoxin, which have anti-inflammatory activity in vivo or in vitro as well as structural similarities with rofecoxib. The deoxypodophyllotoxin for presenting selectivity for COX... (Complete abstract click electronic access below) / Doutor

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The cyclooxygenase 2 (Cox 2) is a molecular indicator of prognosis marker and its expression is associated with progression of mammary tumors in dogs. The purpose of this study was to investigate breast tumors of bitches Cox 2 expression by immunohistochemistry and correlated with the clinical stage, tumor size, lymph node involvement, the classification and the histological grade of carcinomas. We included in this study, 100 female dogs with mammary tumors and 131 samples were analyzed. Histological and COX 2 immunostaining evaluation were conducted. The streptavidin-biotinaperoxidase technique was used in order to do the immunohistochemistry (IHC). The IHC analysis was performaced counting the number of positive-staining cells in ten fields and the staining intensity. The COX 2 staining index was obtained by multiplying the COX 2 staining distribution and intensity scores. This gave a range of COX 2 staining indices of 0 12.Carcinoma complex was the most common histological type that we were diagnosed. The COX 2 expression was observed in the benign and malignant tumors. The weak score is more frequent, and strong score was observed in carcinomas. Simple carcinomas demonstraded a higher number of positive staining cells. There was no positive correlation between the histological type, size and lymph node involvement and the Cox 2 immunostaining. Therefore, COX 2 immunostaining is not a good prognostic factor. / A ciclooxigenase 2 (Cox 2) é um marcador molecular indicador de prognóstico e sua expressão está relacionada com a progressão do tumor mamário na cadela. Tendo isso em vista, o objetivo deste trabalho foi investigar tumores mamários de cadelas a expressão de Cox 2 por meio de imunohistoquímica e correlacionar com o estadiamento clínico, o tamanho tumoral, o envolvimento linfonodal, a classificação e o grau histológico dos carcinomas. Foram incluídas neste estudo, 100 cadelas com neoplasia mamária e dessas, 131 amostras foram analisadas. A avaliação histológica e da imunomarcação de Cox 2 foram conduzidas. Para a imunohistoquímica (IHQ), utilizou-se a técnica de estreptoavidina-biotinaperoxidase. Para análise das lâminas de IHQ contou-se o número de células marcadas em dez campos e verificou-se a intensidade de marcação. O escore de marcação foi obtido pelo produto do número de células marcadas e a intensidade de marcação. O tipo histológico mais frequente diagnosticado foi o carcinoma complexo mamário. A expressão de Cox 2 foi observada nos tumores benignos e malignos. A marcação fraca é mais frequente, sendo a marcação forte observada nos carcinomas. Os carcinomas simples apresentaram maior número de células marcadas. Não houve correlação positiva entre o tipo histológico, tamanho e o envolvimento linfonodal e a imunomarcação de Cox 2. Sendo assim, a imunomarcação de Cox 2 não demonstrou ser um bom fator de prognóstico. / Mestre em Ciências Veterinárias

Orientador: Fernando Antonio Santos Coelho / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Química / Made available in DSpace on 2018-08-25T19:30:44Z (GMT). No. of bitstreams: 1 SouzaFilho_LuisGustavode1974-_D.pdf: 8902904 bytes, checksum: 85fa958ae1d753dea72d1d460737db4e (MD5) Previous issue date: 2014 / Resumo: Neste trabalho descrevemos uma nova abordagem para a síntese de ciclopentenonas substituídas com potencial atividade anti-inflamatória. As ciclopentenonas desempenham diversas atividades biológicas, a saber: anti-inflamatória, antineoplásica e antiviral. Devido a sua importância biológica sintetizamos várias ciclopentenonas utilizando adutos de Morita-Baylis-Hillman, como substrato. A sequencia se baseou no uso de uma reação de adição 1,4 catalisada por ródio, com adutos de Morita-Baylis-Hillman, levando à formação de cinamatos alfa-substituídos com elevada estereosseletividade E. A partir desses últimos, uma sequencia de etapas permitiu a preparação de 4 diferentes ciclopentenonas, em 7 etapas, com rendimentos globais variando de 10 a 30%. As ciclopentenonas sintetizadas tiveram seu perfil anti-inflamatório avaliado em modelos experimentais de inflamação não alérgica, edema de pata e peritonite ¿ in vivo e ensaio de agregação plaquetária ¿ in vitro. Demonstramos, através de tais experimentos, que essas ciclopentenonas inibem o processo inflamatório, ou seja, reduzem do edema de pata e a migração celular para a cavidade abdominal, além de uma possível indicação do mecanismo de ação dessas moléculas sobre a isoenzima ciclooxigenase tipo 2 (COX-2). Os ensaios de agregação plaquetária nos permitiram propor que o mecanísmo de ação possa ser por inibição de COX-2, já que tais ensaios mostraram que essas moléculas não inibem a enzima COX-1. Esse é o primeiro trabalho descrevendo a síntese de ciclopentenonas substituídas a partir de adutos de Morita-Baylis-Hillman / Abstract: This paper describes a new approach for the synthesis of substituted cyclopentenones with potential anti-inflammatory activity. The cyclopentenones play diverse biological activities, namely: anti-inflammatory, anticancer and antiviral. Due to their biological importance synthesize various cyclopentenones using Morita-Baylis-Hillman as substrate. The sequence was based on the use of a 1,4 addition reaction catalyzed by rhodium, with Morita-Baylis-Hillman, leading to the formation of alpha-substituted cinnamates with high stereoselectivity E. From the latter, a sequence of steps allowed the preparation of 4 different cyclopentenones in 7 steps with overall yields ranging from 10 to 30%. The cyclopentenones synthesized had their anti-inflammatory profile assessed in experimental models of non-allergic inflammation, paw edema and peritonitis ¿ in vivo and test platelet aggregation - in vitro. Demonstrated through such experiments , these cyclopentenones inhibit the inflammatory process, ie , reduce paw edema and cell migration into the abdominal cavity, as well as a possible indication of the mechanism of action of these molecules on the isoenzyme cyclooxygenase type 2 (COX-2). The platelet aggregation assays allowed us to propose that the mechanism of action may be through inhibition of COX - 2, since these trials have shown that these molecules do not inhibit COX-1 enzyme. This is the first paper describing the synthesis of substituted cyclopentenones from Morita-Baylis-Hillman adducts / Doutorado / Quimica Organica / Doutor em Ciências

Mycobacteria are multifaceted pathogens capable of causing both acute disease as well as an asymptomatic latent infection. Protective immunity against pathogenic mycobacteria depends principally on cell-mediated immunity executed by efficient anti-infectious functions of type 1 T helper (Th1) subset of CD4+ T cells. The polarization of Th1 responses is orchestrated by IL-12 secreted by antigen presenting cells (APCs) such as macrophages and dendritic cells (DCs). A hallmark of Th1 type CD4+ T cells is the production of IFN-γ that activates plethora of innate cell-mediated immunity. It is well known that cytokines such as IFN-γ, IL-12 and TNF-α are required for control of mycobacterial infection in humans as well as in mice. However, it remains unclear that why the immune response controls mycobacteria, but does not eradicate infection suggesting critical roles for series of survival strategies employed by pathogenic mycobacteria. In general, these evasion strategies include blockade of phagosome-lysosome fusion, secretion of ROI antagonistic proteins like superoxide dismutase & catalase, inhibition of processing of its antigens for presentation to T cells, induced secretion of immunosuppressive cytokines like IL-10 and TGF-β etc. that ultimately suppress the secretion of IL-12 and IFN-γ from APCs and T cells respectively, culminating in a skewed Th1/Th2 balance towards unprotective Th2 responses. Th2 cells secrete IL-4, IL-5, IL-9, IL-10 and IL-13 but are deficient in clearing intracellular infections including pathogenic mycobacteria. This eventually leads to inhibition of host’s immuno-protective responses with concomitant increase in the vulnerability to chronic mycobacterial infection. In this intricate process, modulation of cyclooxygenase-2 (COX-2) levels, a key enzyme catalyzing the rate-limiting step in the inducible production of prostaglandin E2 (PGE2), by mycobacteria like Mycobacterium bovis BCG assumes critical importance in influencing the overall host immune response. PGE2, an immunosuppressive member of prostaglandin family, is known to restrain production of IL-12, as well as reactive oxygen intermediates. PGE2-mediated inhibition of IL-12R, diminishes IL-12 responsiveness of macrophages and dendritic cells. PGE2 also inhibits the secretion of IFN-γ, which is important in activating T cells and macrophages. In contrast, PGE2 promotes IL-10 production by macrophages, dendritic cells and Th1-to-Th2 shift of acquired immune responses by inhibiting IL-2 and enhancing IL-4 production. Albeit, mitogen-activated protein kinase (MAPK) and nuclear factor-kappa B (NF-κB) signaling pathways are generally believed to be involved, little is known about the signaling molecules playing significant roles upstream of MAPK and NF-κB pathways during mycobacteria triggered COX-2 expression. Further, information on early receptor proximal signaling mechanisms essential during mycobacteria mediated induction of COX-2 remains scanty. In this regard, signaling cascade triggered upon recognition of mycobacterial components by pattern recognition receptors (PRR) signify as critical event in overall regulation of cell fate decisions. PRR like Toll like receptor (TLR2) and nucleotide-binding oligomerization domain 2 (NOD2) are two nonredundant recognition mechanisms of pathogenic mycobacteria. Several components of mycobacteria have been identified as being responsible for TLR2-dependent activation including 19-kDa lipoprotein, lipomannan etc.; while NOD2 recognizes mycobacterial peptidoglycans through its interaction with muramyl dipeptide (MDP). Interestingly, although mycobacteria reside within phagolysosomes of the infected macrophages, many cell wall antigens like lipoarabinomannan (LAM), phosphatidyl-myo-inositol mannosides (PIM), trehalose 6,6′-dimycolate (TDM; cord factor), PE/PPE family proteins etc., are released and traffic out of the mycobacterial phagosome platform into endocytic compartments. Importantly, these antigens could gain access to the extracellular environment in the form of exocytosed vesicles. In this perspective, PIM represents a variety of phosphatidyl-myo-inositol mannosides (PIM) 1-6 containing molecules and are integral component of the mycobacterial envelope. Further, PIM2 is a known TLR2 agonist and reported to activate NF-κB, AP-1, and MAPK suggesting that mycobacterial envelope antigen PIM2 could modulate the inflammatory responses similar to mycobacteria bacilli. In this context, we explored the signaling events modulated by M. bovis BCG, and role for TLR2 and NOD2 in this intricate process, to trigger the expression of COX-2 in macrophages. Our studies demonstrated that M. bovis BCG triggered TLR2-dependent signaling leads to COX-2 expression and PGE2 secretion in vitro in macrophages and in vivo in mice. Further, the presence of PGE2 could be demonstrated in sera or CSF of tuberculosis patients. Similarly, mycobacterial TLR2 agonist PIM2 and NOD2 ligand MDP triggered COX-2 expression in macrophages. The induced COX-2 expression in macrophages either by M. bovis BCG or PIM2 or MDP was dependent on NF-κB activation, which was in turn mediated by iNOS/NO and Wnt-β-Catenin dependent participation of the members of Notch1-PI3K signaling cascade. Importantly, loss of iNOS activity either in iNOS null macrophages or by pharmacological intervention in wild type macrophages severely abrogated M. bovis BCG ability to trigger the generation of Notch1 intracellular domain (NICD) as well as activation of PI3K signaling cascade. On contrary, treatment of macrophages with SIN-1, an NO donor, resulted in a rapid increase in generation of NICD, activation of PI3K pathway as well as the expression of COX-2. Interestingly, pharmacological inhibition as well as siRNA mediated knockdown of Wnt-β-Catenin signaling compromised ability of M. bovis BCG to induce activation of Notch1-PI3K signaling and drive COX-2 expression. Concomitantly, activation of Wnt-β-Catenin signaling by LiCl triggered activation of Notch1 and PI3K pathway as well as COX-2 expression. Stable expression of NICD in RAW 264.7 macrophages resulted in augmented expression of COX-2. Further, signaling perturbation experiments suggested involvement of the cross-talk of Notch1 with PI3K signaling cascade. In this perspective, we propose TLR2 and NOD2 as two major receptors involved in mycobacteria mediated activation of Notch1PI3K signaling, and the activation of iNOS/NO and Wnt-β-Catenin signaling axis as obligatory early receptor proximal signaling events during mycobacteria induced COX-2 expression in macrophages. Functional characterization of mycobacterial antigens that are potent modulators of host immune responses to pathogens by virtue of induced expression of COX-2 assumes critical importance for deciphering pathogenesis of mycobacterial diseases as well as to identify novel therapeutic targets to combat the disease. In this context, a group of novel antigens carried by M. tuberculosis that are expressed upon infection of macrophages belong to PE and PPE family of proteins. Ten percent of the coding capacity of M. tuberculosis genome is devoted to the PE and PPE gene family members, exemplified by the presence of Pro-Glu (PE) and Pro-Pro-Glu (PPE) motifs near the N-terminus of their gene products. Many members of the PE family exhibit multiple copies of polymorphic guanine-cytosine– rich sequences (PGRS) at the C-terminal end, which are designated as the PE_PGRS family of proteins. A number of PE/PPE proteins associate with the cell wall and are known to induce strong T & B cell responses in humans. However information related to effects of PE/PPE antigens on the maturation and functions of human dendritic cells and eventual modulation of T cell responses as well as underlying signaling events remains obscure. Our results demonstrated that two cell wall associated/secretory PE_PGRS proteins PE_PGRS 17, PE_PGRS 11 and PPE family protein PPE 34 recognize TLR2, induce maturation and activation of human dendritic cells and enhance the ability of dendritic cells to stimulate CD4+ T cells. In addition, tuberculosis patients were found to have a high frequency of T cells specific to PE_PGRS and PPE antigens. We further found that PE/PPE proteins-mediated activation of dendritic cells involves participation of ERK1/2, p38 MAPK and NF-κB signaling pathways. While, PE_PGRS antigens-matured dendritic cells secreted high amounts of inflammatory cytokine IL-12, PPE 34 triggered maturation of dendritic cells was associated with secretion of high amounts of anti-inflammatory cytokine IL-10 but not the Th1-polarizing cytokine IL-12. Consistent with these results, PPE 34-matured dendritic cells favored secretion of IL-4, IL-5 and IL-10 from CD4+ T cells and contributed to Th2 skewed cytokine balance ex vivo in healthy individuals and in patients with pulmonary tuberculosis. Interestingly, PPE 34-skewed Th2 immune response involved induced expression of COX-2 in dendritic cells. Our results suggest that by inducing differential maturation and activation of human dendritic cells, PE/PPE proteins could potentially modulate the initiation of host immune responses against mycobacteria. Taken together, our observations clearly signify the potential role for TLR2 and NOD2 triggering by M. bovis BCG in activating receptor proximal Notch1-PI3K signaling during induced COX-2/PGE2 expression which represents a crucial immune subversion mechanism employed by mycobacteria in order to suppress or attenuate host immune responses. Further, differential maturation of human dendritic cells by PE_PGRS and PPE antigens as well as their ability to stimulate CD4+ T cells towards Th1 and Th2 phenotype respectively, improves our understanding about host-mycobacteria interactions and clearly paves a way towards the development of novel combinatorial therapeutics.

The zona-pellucida (zona, ZP) is an adhesion-refractory, acellular coat enclosing the rapidly growing, free-living mammalian preimplantation embryo which undergoes successive cleavage divisions to form the blastocyst, composed of ICM-cells surrounded by outer TE-cells. For further development, the blastocyst must ‘hatch’ or ‘escape’ out of the zona before it can implant into the endometrium for further development (Fig. 5.1A). Hence, the event of hatching or ‘zona escape’ assumes critical importance for the establishment of a successful pregnancy. The golden-hamster blastocyst offers a very unique paradigm to understand hatching, whereby upon attainment of a fully-expanded state, the blastocyst undergoes a dramatic (and molecularly unexplained) deflation event, followed by appearance of TE-derived dynamic cellular projections called TE-projections, whose appearance in an embryonic-stage and -time dependant manner suggest an intimate association with the hatching phenomenon (Fig. 5.1B). Thirdly, embryo-derived zonalytic proteases have been shown to bring about a focal-lysis of the ZP followed by global zona dissolution. Earlier work in the laboratory had demonstrated the intimate involvement of signaling molecules like LIF, HB-EGF, TGF-β and (ER)-α with hatching (Seshagiri et al., 2002, 2009). Investigations also revealed the involvement of cysteine-proteases of the cathepsin (cts) family, especially cts-L, -B and-P to be involved in zona lysis (Sireesha et al., 2008). In order to achieve a better understanding of mammalian preimplantation development, especially hatching, it was important to investigate the role and impact of other critical regulators of developmental and reproductive physiology. COX-2 is one such key signaling moiety and it was decided to investigate the role, if any, of COX-2 and its derived PGs in hamster peri-implantation events. COX-2 transcripts and immunoreactive COX-2 protein were detected in the different preimplantation stages, from 8-cell onwards. COX-2 protein was abundant in both the ICM and TE, but was especially enriched in the TE-cells of the late blastocyst. In order to investigate the function of this enzyme in preimplantation development and hatching, two very-specific inhibitors of COX-2 catalytic action, NS-398 and CAY-10404, were tested in identical concentrations of 25, 50 and 75 μM on in vitro cultured hamster blastocysts. In order to assess the impact of COX-2 inhibition on an embryo-stage and time-dependant manner, inhibitors were tested on freshly recovered 8-cell embryos or early blastocysts, continuously for 72 h or 48 h, respectively. COX-2-selective inhibitors inhibited hamster blastocyst hatching in a dose-dependant manner with maximum inhibition observed in the 75 μM dose. Surprisingly, there was a profound dose-dependent failure of deflation of late-blastocysts upon inhibitor treatment and embryos which hatched, did so in an inflated state and retained intact zonae in cultures. Moreover, embryos subjected to NS-398 treatment phenocopied those subjected to CAY-10404 treatment. Results demonstrate that the effect of inhibitors, and hence the need for COX-2 mediated signaling events is more pronounced in 8¬cell embryos than with early-blastocysts, indicating that COX-2 dependant molecular and cellular processes required for blastocyst morphogenesis and ZP-lysis may have been initiated prior to compaction and cavitation. The reversal of effects of COX-2 inhibition on hatching with exogenous addition of PGE2 and Iloprost (a stable PGI2 analogue) to inhibitor cultures, show that COX-2-derived eicosanoids could, in effect bring about hamster hatching, which is in agreement with previous reports (Davis et al., 1999) and augment peri-implantation development including hatching (Huang et al., 2003). Additionally, it has been successfully demonstrated that PGE2 was superior to PGI2 in augmenting blastocyst hatching in inhibitor-cultures. In this study, the modulation of critical cts-L, -B, -P proteases in COX-2 mediated hamster zona hatching has been verified by quantifying cts in transcripts in control and inhibitor-subjected embryonic samples which was further substantiated by the decreased intra-embryonal protein levels of cts-L and -P. These results demonstrate that COX-2 mediated signaling components directly and effectively modulate hamster preimplantation development, especially zona-hatching phenomenon by transcriptional-regulation of the critical zonalytic proteases. Another potential hatching-associated molecule i.e., NF-κB which is known to exert a great deal of influence on overall reproductive and developmental biology, was investigated in this study. Its specific effects on mammalian preimplantation development, especially hatching, remain totally uninvestigated. This formed the rationale to investigate the reach and impact of NF-κB signaling network in the modulation of peri-hatching events. Transcripts and immunoreactive NF-κB protein of crucial pathway-components like IKK, IκB-β and RelA were detected from 8-cell embryo to the zona-free blastocyst. In order to ascertain the impact of NF-κB signaling on peri-hatching events, two very-specific inhibitors of the NF-κB pathway, BAY-11-7082 and JSH-23 were employed which acted at two strategic signaling points. In order to assess the impact of NF-κB inhibition on an embryo-stage and time-dependant manner, inhibitors were tested on freshly recovered 8-cell embryos or early blastocysts, continuously for 72 h or 48 h, respectively. NF-κB-selective inhibitors inhibited blastocyst hatching in a dose-dependent manner. Interestingly, a profound dose-dependent failure of deflation of late-blastocysts upon inhibitor treatment was observed and embryos which hatched did so in an inflated state and also retained intact zonae in cultures. Moreover, embryos subjected to BAY-11-7082 treatment phenocopied those subjected to JSH-23 treatment, indicating specificity of inhibitor action. Time-course experiments demonstrated that the need for efficient NF-κB mediated signaling is distinctively more for 8-cell embryos than early-blastocysts, indicating that NF-κB dependant molecular and cellular processes required for blastocyst morphogenesis and ZP-lysis may have been initiated prior to compaction and cavitation. Moreover, modulation of zonalysins cts-L, -B and -P by NF-κB-signaling, during the event of zona lysis, both by real-time quantitation of its transcripts and intracellular protein levels has been demonstrated. These results demonstrate that NF¬κB mediated signaling components directly and effectively modulate hamster preimplantation development, especially zona-hatching phenomenon by transcriptional-regulation of the critical zonalytic proteases. The profound inhibition of hatching and effects on blastocyst morphogenesis observed by inhibition of COX-2 and NF-κB signaling systems demonstrate a fundamental need of the growing embryo for these critical signaling moieties. Moreover, the underlying similarity of consequences obtained upon inhibition of both signaling networks i.e., NF-κB and COX-2, perhaps indicate a linear mode of signaling between these principles. It remains to be tested, though, if it really is the case. A striking observation made in this study was the detection of immunoreactive signals for critical signaling moieties like ER-α, COX-2 and RelA onto TEPs of the deflated hamster blastocyst, in addition to earlier TEP-localisation of cathepsins. A B C (Figure) ENDOMETRIUM ENDOMETRIUM ENDOMETRIUM Fig 5.1. Schematic representation of the role of molecular and cellular factors in the regulation of concordant phenomena of mammalian blastocyst hatching and endometrial implantation. (A) Depicts a zona-intact well-formed blastocyst. Preimplantation embryo development and blastocyst formation involves close cooperation between several molecular principles (discussed in sections 1.3.1 to 1.3.3), (B) as the embryo prepares to hatch, prior to implantation, it initiates egression from the non-adhesive ZP coat by cathepsin (cts) protease-mediated lysis of zona (pink circles); there is concomitant appearance of cellular principles such as TEPs (undulating projections shown in green). Of interest is the intimate association of hatching-promoting molecules such as COX-2, NF-κB, ER-α, Cts etc. with the TEPs. (C) depicts a zona-free, TEP-rich blastocyst initiating implantation into the maternal endometrium. It is possible, that the embryonic TEPs with the associated hatching-regulatory molecules are also critical for implantation phenomena during the embryo-maternal recognition and implantation during the establishment of early pregnancy. Preliminary results indicate that TEPs could be the site of membrane lipid-rafts, focal points of membrane-based signaling. The definitive role of TEPs in peri-hatching events is yet to be confirmed, but it is presumed that these actin-based undulating structures, harboring several key molecules involved in peri-implantation events in the embryo as well as the maternal uterus could be instrumental in successfully bringing about the concomitant processes of hatching and implantation. Interestingly, during rodent implantation (hamster, guinea-pig, mouse and rat), the blastocyst orients in such a way that the ICM is oriented away from the endometrium and, at least in the hamster, the TEP-carrying abembryonic (mural) pole remains closest to the luminal epithelium (LE) (Gonzales et al., 1996b; Seshagiri et al., 2009; Fig. 5.1C). In contrast, in humans and other primates, the embryonic pole is closest to LE before implantation (Kirby, 1971; Lee and DeMayo, 2004). Although direct evidence is lacking, but these observations gives rise to a possibility that both hatching and implantation could be intimately related to the polar appearance of TEPs in the embryo. Several key signaling molecules like ER-α, LIF, HB-EGF and TGF-β have been already demonstrated to play crucial roles in mammalian hatching. In this thesis, we have exemplified the need for COX-2 mediated prostanoid signaling and the pleotropic NF-κB signaling system in bringing about mammalian blastocyst hatching. How exactly do these molecular entities communicate among themselves and with cellular principles like TEPs thereby effectively enabling peri-implantation development, remain to be understood. Taken together, these results demonstrate, for the first time, the involvement of embryo-derived signaling molecules, like COX-2 and NF-κB in an embryo stage-and time-dependant manner in mammalian peri-implantation events, especially blastocyst hatching. The association of TEPs with key molecules common to embryonic and maternal preparation for hatching and implantation, respectively, indicates towards a molecular and cellular continuity between the concomitant events. These fundamental findings on hamster blastocyst biology have profound clinical implications in the management of human infertility. (For figures pl see the abstract file).

We have studied aspirin as a potential chemopreventive for colorectal cancer, completing Phase I studies on aspirin pharmacology and potential biomarker assays (prostaglandins, PGE2 and PGF(2α) and cyclooxygenase modulation) in normal human subjects. These studies have determined the optimal dose of aspirin for future Phase IIa and IIb chemopreventive trials in high-risk cohorts of patients for colon cancer. Aspirin's effects on rectal prostaglandins are prolonged, detectable even after aspirin and its metabolite are removed from the plasma. Aspirin-mediated inhibition of prostaglandin production in the human rectal epithelium may be related to direct suppression of cyclooxygenase transcription and not to enzyme inactivation by acetylation. A systematic method to monitor adherence (self- report, telephone contact, pill count, and microelectronic monitoring) has been established for future trials. Strategies to improve recruitment of high-risk cohorts have been developed. Phase IIa non-randomized studies with aspirin at 81 mg in high-risk cohorts (resected Duke's A colon cancer, Duke's C colon cancer treated with adjuvant therapy and disease-free at 5 years, history of colon adenomas > 1 cm, two or more first-degree relatives with colon cancer, and familial adenomatous polyposis and hereditary non-polyposis colorectal cancer syndromes) are currently being conducted for surrogate end- point biomarker (prostaglandins, cyclooxygenase, cellular mucins, and proliferation) modulation.

What is known and objective: Although non-steroidal anti-inflammatory drugs (NSAIDs) have been studied in randomized, controlled trials and meta-analyses in an effort to determine their cardiovascular (CV) risks, no consensus has been reached. These studies continue to raise questions, including whether cyclooxygenase-2 (COX-2) selectivity plays a role in conferring CV risk. We performed a meta-analysis of current literature to determine whether COX-2 selectivity leads to an increased CV risk. Methods: We utilized randomized, controlled trials and prospective cohort studies. We selected eight NSAIDs based on popularity and COX selectivity and conducted a search of the MEDLINE, EMBASE, and Cochrane databases. Primary endpoints included any myocardial infarction (MI), any stroke, CV death, and a combination of all three (composite CV outcomes). Twenty-six studies were found that met inclusion and exclusion criteria. Comparisons were made between all included drugs, against placebo, and against non-selective NSAIDs (nsNSAIDs). Drugs were also compared against COX-2 selective inhibitors (COXIBs) with and without inclusion of rofecoxib. Results and discussion: Incidence of MI was increased by rofecoxib in all comparison categories [all NSAIDs (OR: 1·811, 95% CI: 1·379–2·378), placebo (OR: 1·655: 95% CI: 1·029–2·661), nsNSAIDs (OR: 2·155, 95% CI: 1·146–4·053), and COXIBs (OR: 1·800, 95% CI: 1·217–2·662)], but was decreased by celecoxib and naproxen in the COXIB comparison [(OR: 0·583, 95% CI: 0·396–0·857) and (OR: 0·609, 95% CI: 0·375–0·989, respectively]. Incidence of stroke was increased by rofecoxib in comparisons with all NSAIDs and other COXIBs [(OR: 1·488, 95% CI: 1·027–2·155) and (OR: 1·933, 95% CI: 1·052–3·549), respectively]. Incidence of stroke was decreased by celecoxib when compared with all NSAIDs, nsNSAIDs, and COXIBs [(OR: 0·603, 95% CI: 0·410–0·887), (OR: 0·517, 95% CI: 0·287–0·929), and (OR: 0·509, 95% CI: 0·280–0·925), respectively]. No NSAID reached statistical significance in regard to CV death. Incidence of the composite endpoint was increased by rofecoxib when compared against all NSAIDs, placebo, and other COXIBs [(OR: 1·612, 95% CI: 1·313–1·981), (OR: 1·572, 95% CI: 1·123–2·201) and (OR: 1·838, 95% CI: 1·323–2·554), respectively]. Incidence of composite endpoint was decreased by celecoxib in the all NSAIDs and COXIBs comparisons [(OR: 0·805, 95% CI: 0·658–0·986) and (OR: 0·557, 95% CI: 0.404–0.767), respectively]. When rofecoxib was removed from the COXIBs group, no difference was found with any comparison, suggesting rofecoxib skewed the data. What is new and conclusion: This instead of the meta-analysis suggests that COX-2 selectivity may not play a role in the CV risk of NSAIDs. Rofecoxib was the only drug to demonstrate harm and skewed the data of the COX-2 selective group.