Osteomyelitis is an inflammatory disease of the bone that is characterized by the presence of necrotic bone tissue and increased osteoclast activity. Staphylococcus aureus is responsible for approximately 80% of all cases of human osteomyelitis. While the disease is especially difficult to treat, the pathogenesis of S. aureus-induced osteomyelitis is poorly understood. Elucidating the molecular mechanisms by which S. aureus induces osteomyelitis could lead to a better understanding of the disease and its progression and development of new treatments. Osteoblasts can produce several soluble factors that serve to modulate the activity or formation of osteoclasts. Receptor activator of NF-B ligand (RANK-L) and prostaglandin E 2 (PGE 2 ) are two such molecules which can promote osteoclastogenesis and stimulate bone resorption. In addition, previous studies in our laboratory have shown that osteoblasts produce inflammatory cytokines, such as interleukin 6, following infection with S. aureus, which could induce COX-2 and in turn PGE 2 , further modulating osteoclast recruitment and differentiation. Therefore, we hypothesized that following infection with S. aureus, osteoblasts will express increased levels of RANK-L and PGE 2 . The results presented in this study provide evidence for the first time that RANK-L mRNA and protein and PGE 2 expression are upregulated in S. aureus-infected primary osteoblasts. In addition, through the use of the specific COX-2 inhibitor NS 398, we show that when PGE 2 production is inhibited, RANK-L production is decreased. These data suggest a mechanism whereby osteoblasts regulate the production of RANK-L during infection.Osteomyelitis is a severe infection of bone tissue that results in progressive inflammatory destruction of bone (41). The gram-positive organism Staphylococcus aureus is the most common causative agent of osteomyelitis, accounting for approximately 80% of all human cases (27). It is often necessary that infected bone be debrided, tissues reconstructed, and longterm antibiotic therapy utilized (18). The current treatment for osteomyelitis is often traumatic and expensive and often leads to further selection of antibiotic-resistant strains of S. aureus. The growing incidence of antibiotic-resistant S. aureus strains can explain the recurrent attacks of osteomyelitis in patients undergoing therapy. In addition, the pathogenesis of S. aureusinduced osteomyelitis is poorly understood. Elucidating the mechanisms by which S. aureus induces osteomyelitis could therefore lead to a better understanding of the disease, its progression, and development of new treatments.Bone remodeling involves a continuous, coordinated equilibrium between bone synthesis and bone resorption, and two cell populations are responsible for the continual process (23). Osteoclasts drive the resorption of bone by acidification and release of lysosomal enzymes, while osteoblasts produce components of the bone matrix, principally type I collagen. Osteoblasts also produce factors which serve to modulate the ...