Non-steroidal anti-inflammatory drugs and cyclooxigenase-2 selectivity in Gastroenterology.

The discovery of, at least, two isoforms of the enzyme cyclooxygenase, name d by the numbers 1 and 2, has updated our knowledge about the NSAID. This h as led investigators to reconsider what we can expect from this kind of dru gs. The two isoforms share enzimatic and structural properties, although they a re regulated differently, at molecular level and can be distiguished from t heir functions, although an overlap of roles between them do exist. The main goal of the developement of highly selective inhibitors is to impr ove gastric tolerability. The classical NSAID inhibit preferentially the is oform 1 of the cyclooxygenase, in vitro, which appears to be dangerous, acc ording to gastrointestinal safety profile. The new compounds with high selectivity for the isoform 2 of the cyclooxyge nase could be better tolerated at gastrointestinal level. Meanwhile these c ompounds also could have a potential use in several diseases such as colorr ectal cancer and neurodegenerative processes. The potential ocurrence of si de effects, perhaps related with renal function, should be noted. Finally l arge controlled clinical trials are needed to estimate the therapeutic adva ntages which can be offered by the new highly selective NSAID, and the pote ntial consequences which can result from the isoform 2 of the cyclooxygenas e prolonged inhibition.