These complexities were well demonstrated in a recent study where an increase in VEGF levels in Cox-2 positive and Cox-2 negative pancreatic cancer cells was seen after treatment with high concentrations of Cox-2 inhibitors, suggesting that the relationship between Cox-2 protein inhibition and VEGF or Cox-2 promoter expression may not always be tightly linked [47]. The gene discussed is PTGS2; the disease is familial pancreatic carcinoma.