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Inhibition of angiogenesis by nonsteroidal anti-inflammatory drugs: Insight into mechanisms and implications for cancer growth and ulcer healing


Angiogenesis, the formation of new capillary blood vessels, is essential not only for the growth and metastasis of solid tumors, but also for wound and ulcer healing, because without the restoration of blood flow, oxygen and nutrients cannot be delivered to the healing site1,2. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, indomethacin and ibuprofen are the most widely used drugs for pain, arthritis, cardiovascular diseases and, more recently, the prevention of colon cancer and Alzheimer disease3,4,5,6,7. However, NSAIDs produce gastroduodenal ulcers in about 25% of users (often with bleeding and/or perforations) and delay ulcer healing8,9, presumably by blocking prostaglandin synthesis from cyclooxygenase (COX)-1 and COX-2 (ref. 10). The hypothesis that the gastrointestinal side effects of NSAIDs result from inhibition of COX-1, but not COX-2 (ref. 11), prompted the development of NSAIDs that selectively inhibit only COX-2 (such as celecoxib and rofecoxib). Our study demonstrates that both selective and nonselective NSAIDs inhibit angiogenesis through direct effects on endothelial cells. We also show that this action involves inhibition of mitogen-activated protein (MAP) kinase (ERK2) activity, interference with ERK nuclear translocation, is independent of protein kinase C and has prostaglandin-dependent and prostaglandin-independent components. Finally, we show that both COX-1 and COX-2 are important for the regulation of angiogenesis. These findings challenge the premise that selective COX-2 inhibitors will not affect the gastrointestinal tract and ulcer/wound healing.

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Figure 1: In vitro angiogenesis.
Figure 2: Effects of indomethacin and NS-398 on ERK2 activity in rat primary endothelial and HMVECs.
Figure 3: Effects of indomethacin and NS-398 on ERK2 activity and ERK2 nuclear translocation in rat primary endothelial cells.
Figure 4: Serum-starved rat primary endothelial cells or serum-deprived HMVECs were treated for 16 h with either vehicle (controls), 0.


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The authors thank D.T. Vo, B. Gretzer and M. Tomikawa for technical assistance, and R. Pai for discussions. This work was supported by the Medical Research Service of the Department of Veterans Affairs, Merit Review (A.S.T.) and Research Enhancement Award Programs.

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Correspondence to Andrzej S. Tarnawski.

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Jones, M., Wang, H., Peskar, B. et al. Inhibition of angiogenesis by nonsteroidal anti-inflammatory drugs: Insight into mechanisms and implications for cancer growth and ulcer healing. Nat Med 5, 1418–1423 (1999).

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