Notably, the upregulation of COX-2 and PGE synthase (PGES) in pyometra cases, and during the DE and AE stages coincides with TLR-2/4 upregulation, and LPS stimulation synchronously increases COX-2 and mPGES-1 expression, enhancing PGE2 synthesis [60]. Here, PTGS2 is linked to pyometritis.