(COX-2)-derived PGE2 is critical for the integrity and function of renal medullary cells during antidiuresis. The present study extended our previous finding that tonicity-induced COX-2 expression is further stimulated by the major COX-2 product PGE2 and investigated the underlying signaling pathways and the functional relevance of this phenomenon. Hyperosmolality stimulated COX-2 expression and activity in Madin-Darby canine kidney (MDCK) cells, a response that was further increased by PGE2-cAMP signaling, suggesting the existence of a positive feedback loop. This effect was diminished by AH-6809, an EP2 antagonist, and by the PKA inhibitor H-89, but not by AH-23848, an EP4 antagonist. The effect of PGE2 was mimicked by forskolin and dibutyryl-cAMP, suggesting that the stimulatory effect of PGE2 on COX-2 is mediated by a cAMP-PKAdependent mechanism. Accordingly, cAMP-responsive element (CRE)-driven reporter activity paralleled the effects of PGE2, AH-6809, AH-23848, H-89, forskolin, and dibutyryl-cAMP on COX-2 expression. In addition, the stimulatory effect of PGE2 on tonicity-induced COX-2 expression was blunted in cells transfected with dominantnegative CRE binding (CREB) protein, as was the case in a COX-2 promoter reporter construct in which a putative CRE was deleted. Furthermore, PGE2 resulted in PKA-dependent phosphorylation of the pro-apoptotic protein Bad at Ser155, a mechanism that is known to inactivate Bad, which coincided with reduced caspase-3 activity during osmotic stress. Conversely, pharmacological interruption of the PGE 2-EP2-cAMP-PKA pathway abolished Ser155 phosphorylation of Bad and blunted the protective effect of PGE 2 on cell survival during osmotic stress. These observations indicate the existence of a positive feedback loop of PGE 2 on COX-2 expression during osmotic stress, an effect that apparently is mediated by EP2-cAMP-PKA signaling, and that contributes to cell survival under hypertonic conditions. cyooxygenase-2; prostaglandin E 2; osmoadaptation; apoptosis; survival factor THE INTERSTITIAL ENVIRONMENT of the renal medulla is characterized by extremely high interstitial osmolalities and low oxygen tension (34). Nevertheless, medulla-resident cells not only have the ability to survive in this hostile environment but also to function normally. This feature is of integral importance for maintaining the kidneys' function in regulating systemic electrolyte and fluid homeostasis.A characteristic feature of renal medullary cells is their high capacity for production of prostaglandins (PG) (4). PGs are autacoids acting close to their site of formation and contribute essentially to the regulation of tubular solute and water reabsorption and adjusting medullary blood flow to metabolic requirements (12,32,34). Moreover, PGs promote the adaptation of renal medullary cells to high extracellular osmolalities by virtue of enhancing the expression of osmoprotective genes (29,35,37). The formation of PGs depends on the sequential action of cytosolic phospholipase A 2 (cPLA 2 ), which releases ...