PTGS2 and neoplasm: The pro-inflammatory role of CNF1 is also supported by the ability of the toxin to strongly up-regulate the transcription of cyclooxygenase-2 (COX-2) [69], an immediate-early gene induced in response to pro-inflammatory cytokines, tumor promoters, and growth factors and over-expressed in cancers of the lung, colon, stomach, and breast [70].