Recent studies have also implicated cycloxygenase 2 (COX-2, the inducible form of cycloxygenases, enzymes involved in conversion of arachidonic acid to prostaglandin) (Hughes et al., 2005) and trefoil factor 1 (TFF1) (Arumugam et al., 2011) (a stable secretory protein that is upregulated in pancreatic cancer but not expressed in the normal pancreas) in PSC proliferation in response to cancer cell secretions. This evidence concerns the gene PTGS2 and familial pancreatic carcinoma.