Pathogenetic role of cyclooxygenase-2 in hyperprostaglandin E syndrome/antenatal Bartter syndrome: therapeutic use of the cyclooxygenase-2 inhibitor nimesulide

Clin Pharmacol Ther. 2001 Oct;70(4):384-90.


Patients with hyperprostaglandin E syndrome/antenatal Bartter syndrome typically have renal salt wasting, hypercalciuria with nephrocalcinosis, and secondary hyperaldosteronism. Antenatally, these patients have fetal polyuria, leading to polyhydramnios and premature birth. Hyperprostaglandin E syndrome/antenatal Bartter syndrome is accompanied by a pathologically elevated synthesis of prostaglandin E(2), thought to be responsible for aggravation of clinical symptoms such as salt and water loss, vomiting, diarrhea, and failure to thrive. In this study administration of the cyclooxygenase-2 (COX-2) specific inhibitor nimesulide to patients with hyperprostaglandin E syndrome/antenatal Bartter syndrome blocked renal prostaglandin E(2) formation and relieved the key parameters hyperprostaglandinuria, secondary hyperaldosteronism, and hypercalciuria. Partial suppression of serum thromboxane B(2) synthesis resulting from platelet COX-1 activity and complete inhibition of urinary 6-keto-prostaglandin F(1alpha), reflecting endothelial COX-2 activity, indicate preferential inhibition of COX-2 by nimesulide. Amelioration of the clinical symptoms by use of nimesulide indicates that COX-2 may play an important pathogenetic role in hyperprostaglandin E syndrome/antenatal Bartter syndrome. Moreover, on the basis of our data we postulate that COX-2-derived prostaglandin E(2) is an important mediator for stimulation of the renin-angiotensin-aldosterone system in the kidney.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • 6-Ketoprostaglandin F1 alpha / urine
  • Adolescent
  • Bartter Syndrome / blood
  • Bartter Syndrome / drug therapy*
  • Bartter Syndrome / physiopathology
  • Bartter Syndrome / urine
  • Blood Platelets / drug effects
  • Blood Platelets / metabolism
  • Child
  • Cyclooxygenase 2
  • Cyclooxygenase 2 Inhibitors
  • Cyclooxygenase Inhibitors / therapeutic use*
  • Dinoprostone / urine
  • Humans
  • Indomethacin / therapeutic use
  • Isoenzymes / metabolism*
  • Kidney / drug effects
  • Kidney / metabolism
  • Membrane Proteins
  • Prostaglandin-Endoperoxide Synthases / metabolism*
  • Prostaglandins E / blood*
  • Prostaglandins E / urine
  • Sulfonamides / therapeutic use*
  • Thromboxane B2 / analogs & derivatives*
  • Thromboxane B2 / analysis
  • Thromboxane B2 / biosynthesis
  • Thromboxane B2 / urine


  • Cyclooxygenase 2 Inhibitors
  • Cyclooxygenase Inhibitors
  • Isoenzymes
  • Membrane Proteins
  • Prostaglandins E
  • Sulfonamides
  • Thromboxane B2
  • 6-Ketoprostaglandin F1 alpha
  • 11-dehydro-thromboxane B2
  • Cyclooxygenase 2
  • PTGS2 protein, human
  • Prostaglandin-Endoperoxide Synthases
  • Dinoprostone
  • nimesulide
  • Indomethacin