Cyclooxygenase 2 (COX‐2) inhibition increases the inflammatory response in the brain during systemic immune stimuli

Non‐steroidal anti‐inflammatory drugs (NSAIDs) and inhibitors of the cyclooxygenase (COX) pathways are currently recommended for the prevention and treatment of several inflammatory diseases, including neurodegenerative disorders. However non‐selective blockade of COX was found to have pro‐inflammatory properties, because they have the ability to alter the plasma glucocorticoid levels that play a critical role in the control of the innate immune response. The present study investigated the role of non‐selective (ketorolac or indomethacin) or specific inhibitors of COX‐1 (SC‐560) and COX‐2 (NS‐398) in these effects. Mice challenged systemically with the endotoxin lipopolysaccharide (LPS) exhibited a robust hybridization signal for numerous inflammatory genes in vascular‐associated cells of the brain and microglia across the cerebral tissue. Ketorolac, indomethacin and NS‐398 significantly increased the ability of LPS to trigger such an innate immune response at time 3 h post challenge, whereas SC‐560 failed to change gene expression in the brain of animals treated with the endotoxin. These data together with the crucial role of COX‐2‐derived prostaglandin E2 (PGE2) in the increase of glucocorticoids during systemic immune stimuli provide evidence that inhibition of this pathway results in an exacerbated early innate immune reaction. This may have a major impact on the use of these drugs in diseases where inflammation is believed to be a contributing and detrimental factor.