Specialized pro-resolving mediators

Specialized pro-resolving mediators (SPM, also termed specialized proresolving mediators) are a large and growing class of cell signaling molecules formed in cells by the metabolism of polyunsaturated fatty acids (PUFA) by one or a combination of lipoxygenase, cyclooxygenase, and cytochrome P450 monooxygenase enzymes. Pre-clinical studies, primarily in animal models and human tissues, implicate SPM in orchestrating the resolution of inflammation. Prominent members include the resolvins and protectins.
SPM join the long list of other physiological agents which tend to limit inflammation (see ) including glucocorticoids, interleukin 10 (an anti-inflammatory cytokine), interleukin 1 receptor antagonist (an inhibitor of the action of pro-inflammatory cytokine, interleukin 1), annexin A1 (an inhibitor of formation of pro-inflammatory metabolites of polyunsaturated fatty acids), and the gaseous resolvins, carbon monoxide (see ), nitric oxide (see ), and hydrogen sulfide (see and ).
The absolute as well as relative roles of the SPM along with other physiological anti-inflammatory agents in resolving human inflammatory responses remain to be defined precisely. However, studies suggest that synthetic SPM that are resistant to being metabolically inactivated hold promise of being clinically useful pharmacological tools for preventing and resolving a wide range of pathological inflammatory responses along with the tissue destruction and morbidity that these responses cause. Based on animal model studies, the inflammation-based diseases which may be treated by such metabolically resistant SPM analogs include not only pathological and tissue damaging responses to invading pathogens but also a wide array of pathological conditions in which inflammation is a contributing factor such as allergic inflammatory diseases (e.g. asthma, rhinitis), autoimmune diseases (e.g. rheumatoid arthritis, systemic lupus erythematosus), psoriasis, atherosclerosis disease leading to heart attacks and strokes, type 1 and type 2 diabetes, the metabolic syndrome, and certain dementia syndromes (e.g. Alzheimer's disease, Huntington's disease).
Many of the SPM are metabolites of omega-3 fatty acids and have been proposed to be responsible for the anti-inflammatory actions that are attributed to omega-3 fatty acid-rich diets.
History.
Through most of its early period of study, acute inflammatory responses were regarded as self-limiting innate immune system reactions to invading foreign organisms, tissue injuries, and other insults. These reactions were orchestrated by various soluble signaling agents such as a) foreign organism-derived N-formylated oligopeptide chemotactic factors (e.g. N-formylmethionine-leucyl-phenylalanine); b) complement components C5a and C3a which are chemotactic factors formed during the activation of the host's blood complement system by invading organisms or injured tissues; and c) host cell-derived pro-inflammatory cytokines (e.g. interleukin 1s), host-derived pro-inflammatory chemokines (e.g. CXCL8, CCL2, CCL3, CCL4, CCL5, CCL11, CXCL10), platelet-activating factor, and PUFA metabolites including in particular leukotrienes (e.g. LTB4), hydroxyeicosatetraenoic acids (e.g., 5-HETE, 12-HETE), the hydroxylated heptadecatreineoic acid, 12-HHT, and oxoeicosanoids (e.g. 5-oxo-ETE). These agents functioned as pro-inflammatory signals by increasing the permeability of local blood vessels; activating tissue-bound pro-inflammatory cells such as mast cells, and macrophages; and attracting to nascent inflammatory sites and activating circulating neutrophils, monocytes, eosinophils, gamma delta T cells, and Natural killer T cells. The cited cells then proceeded to neutralize invading organisms, limit tissue injury, and initiate tissue repair. Hence, the classic inflammatory response was viewed as fully regulated by the soluble signaling agents. That is, the agents formed, orchestrated an inflammatory cell response, but then dissipated to allow resolution of the response. In 1974, however, Charles N. Serhan and his renowned colleagues, Mats Hamberg and Bengt Samuelsson, discovered that human neutrophils metabolize arachidonic acid to two novel products that contain 3 hydroxyl residues and 4 double bonds viz., 5,6,15-trihydroxy-7,9,11,13-icosatetraenoic acid and 5,14,15-trihydroxy-6,8,10,12-icosatetraenoic acid. These products are now termed lipoxin A4 and B4, respectively. While initially found to have in vitro activity suggesting that they might act as pro-inflammatory agents, Serhan and colleagues and other groups found that the lipoxins as well as a large number of newly discovered metabolites of other PUFA possess primarily if not exclusively anti-inflammatory activities and therefore may be crucial for causing the resolution of inflammation. In this view, inflammatory responses are not self-limiting but rather limited by the formation of a particular group of PUFA metabolites that counteract the actions of pro-inflammatory signals. Later, these PUFA metabolites were classified together and termed specialized pro-resolving mediators (i.e. SPM).
Inflammation.
The production and activities of the SPM suggest a new view of inflammation wherein the initial response to foreign organisms, tissue injury, or other insults involves numerous soluble cell signaling molecules that not only recruit various cell types to promote inflammation but concurrently cause these cells to produce SPM which feed back on their parent and other cells to dampen their pro-inflammatory activity and to promote repair. Resolution of an inflammatory response is thus an active rather than self-limiting process which is set into motion at least in part by the initiating pro-inflammatory mediators (e.g. prostaglandin E2 and prostaglandin D2) which instruct relevant cells to produce SPM and to assume a more anti-inflammatory phenotype. Resolution of the normal inflammatory response, then, may involve switching production of pro-inflammatory to anti-inflammatory PUFA metabolites. Excessive inflammatory responses to insult as well as many pathological inflammatory responses that contribute to diverse diseases such as atherosclerosis, diabetes, Alzheimer's disease, inflammatory bowel disease, etc. (see ) may reflect, in part, a failure in this class switching. Diseases caused or worsened by non-adaptive inflammatory responses may by amenable to treatment with SPM or synthetic SPM which, unlike natural SPM, resist in vivo metabolic inactivation. The SPM possess overlapping activities which work to resolve inflammation. SPMs (typically more than one for each listed action) have the following anti-inflammatory activities on the indicated cell types as defined in animal and human model studies:
SPMs also stimulate anti-inflammatory and tissue reparative types of responses in epithelium cells, endothelium cells, fibroblasts, smooth muscle cells, osteoclasts, osteoblasts, goblet cells, and kidney podocytes as well as activate the heme oxygenase system of cells thereby increasing the production of the tissue-protective gaso-transmitter, carbon monoxide (see Carbon monoxide#Normal human physiology), in inflamed tissues.
Biochemistry.
SPM are metabolites of arachidonic acid (AA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), or n-3 DPA (i.e. "7",10"Z",13"Z",19"Z"-docosapentaenoic acid or clupanodonic acid); these metabolites are termed lipoxins (Lx), resolvins (Rv), protectins (PD) (also termed neuroprotectins [NP]), and maresins (MaR). EPA, DHA, and n-3 DPA are n-3 fatty acids; their conversions to SPM are proposed to be one mechanism by which n-3 fatty acids may ameliorate inflammatory diseases (see Omega-3 fatty acid#Inflammation). SPM act, at least in part, by either activating or inhibiting cells through binding to and thereby activating or inhibiting the activation of specific cellular receptors.
Lipoxins.
Human cells synthesize LxA4 and LxB4 by serially metabolizing arachidonic acid (5"Z",8"Z",11"Z",14"Z"-eicosatrienoic acid) with a) ALOX15 (or possibly ALOX15B) followed by ALOX5; b) ALOX5 followed by ALOX15 (or possibly ALOX15B); or c) ALOX5 followed by ALOX12. Cells and, indeed, humans treated with aspirin form the 15"R"-hydroxy Epimer lipoxins of these two 15"S"-lipoxins viz., 15-epi-LXA4 and 15-epi-LXB4, through a pathway that involves ALOX5 followed by aspirin-treated cyclooxygenase 2 (COX2). Aspirin-treated COX-2, while inactive in metabolizing arachidonic acid to prostanoids, metabolizes this PUFA to 15"R"-hydroperoxy-eicosatetraenoic acid whereas the ALOX15 (or ALOX15B) pathway metabolizes arachidonic acid to 15"S"-hydroperoxy-eicosatetraenoic acid. The two aspirin-triggered lipoxins (AT-lipoxins) or epi-lipoxins differ structurally from LxA4 and LxB4 only in the "S" versus "R" chirality of their 15-hydroxyl residue. Numerous studies have found that these metabolites have potent anti-inflammatory activity in vitro and in animal models and in humans may stimulate cells by binding to certain Receptor (biochemistry)s in or on these cells. The following table lists the structural formulae (ETE stands for eicosatetraenoic acid), major activities, cellular receptor targets (where known), and Wikipedia pages giving further information on the activity and synthesis of the lipoxins.
Resolvins.
Resolvins are metabolites of omega-3 fatty acids, EPA, DHA, and 7"Z",10"Z",13"Z",16"Z",19"Z"-docosapentaenoic acid (n-3 DPA). All three of these omega-3 fatty acids are abundant in salt water fish, fish oils, and other seafood. n-3 DPA (also termed clupanodonic acid) is to be distinguished from its n-6 DPA isomer, i.e. 4"Z",7"Z",10"Z",13"Z",16"Z"-docosapentaenoic acid, also termed osbond acid.
EPA-derived resolvins.
Cells metabolize EPA (5"Z",8"Z",11"Z",14"Z",17"Z"-eicosapentaenoic acid) by a cytochrome P450 monooxygenase(s) (in infected tissues a bacterial cytochrome P450 may supply this activity) or aspirin-treated cyclooxygenase-2 to 18"R"-hydroperoxy-EPA which is then reduced to 18"R"-hydroxy-EPA and further metabolized by ALOX5 to 5"S"-hydroperoxy-18"R"-hydroxy-EPA; the later product may be reduced to its 5,18-dihydroxy product, RvE2, or converted to its 5,6-epoxide and then acted on by an epoxide hydrolase to form a 5,12,18-trihydroxy derivative, RvE1. In vitro, ALOX5 can convert 18"S"-HETE to the 18"S" analog of RvE1 termed 18"S"-RvE1. 18"R"-HETE or 18"S"-HETE may also be metabolized by ALOX15 to its 17"S"-hydroperoxy and then reduced to its 17"S"-hydroxy product, Rv3. Rv3, as detected in in vitro studies, is a dihydroxy mixture of 18"S"-dihydroxy (i.e. 18"S"-RvE3) and 18"R"-dihydroxy (i.e. 18"R"-RvE3) isomers, both of which, similar to the other aforementioned metabolites possess potent SPM activity in in vitro and/or animal models. In vitro studies find that ALOX5 can convert 18"S"-hydroperoxy-EPA to the 18"S"-hydroxy analog of RvE2 termed 18"S"-RvE2. 18"S"-RvE2, however has little or no SPM activity and is therefore not considered to be a SPM here. The following table lists the structural formulae (EPA stands for eicosapentaenoic acid), major activities, cellular receptor targets (where known), and Wikipedia pages giving further information on the activity and syntheses.
DHA-derived resolvins.
Cells metabolize DHA (4"Z",7"Z",10"Z",13"Z",16"Z",19"Z"-docosahexaenoic acid) by either ALOX15 or a cytochrome P450 monooxygenase(s) (bacteria may supply the cytochrome P450 activity in infected tissues) or aspirin-treated cyclooxygenase-2 to 17"S"-hydroperoxy-DHA which is reduced to 17"S"-hydroxy-DHA. ALOX5 metabolizes this intermediate to a) 7"S"-hydroperoxy,17"S"-hydroxy-DHA which is then reduced to its 7"S",17"S"-dihydroxy analog, RvD5; b) 4"S"-hydroperoxy,17"S"-hydroxy-DHA which is reduced to its 4"S",17"S"-dihydroxy analog, RvD6; c) 7"S",8"S"-epoxy-17"S"-DHA which is then hydrolyzed to 7,8,17-trihydroxy and 7,16,17-trihydorxy products, RvD1 and RvD2, respectively; and d) 4"S",5"S"-epoxy-17"S"-DHA which is then hydrolyzed to 4,11,17-trihydroxy and 4,5,17-trihydroxy products, RvD3 and RvD4, respectively. These six RvDs possess a 17"S"-hydroxy residue; however, if aspirin-treated cyclooxygenase-2 is the initiating enzyme, they contain a 17"R"-hydroxy residue and are termed 17"R"-RvDs, aspirin-triggered-RvDs, or AT-RvDs 1 thru 6. In certain cases, the final structures of these AT-RvDs is assumed by analogy to the structures of their RvD counterparts. Studies have found that most (and presumably all) of these metabolites have potent anti-inflammatory activity in vitro and/or in animal models. The following table lists the structural formulae, major activities with citations, cellular receptor targets, and Wikipedia pages giving further information on the activity and synthesis of these D series resolvins.
n-3 DPA-derived resolvins.
n-3 DPA (i.e. 7"Z",10"Z",13"Z",16"Z",19"Z"-docosahexaenoic acid)-derived resolvins are recently identified SPM. In the model system used to identify them, human platelets pretreated with aspirin to form acetylated COX2 or the statin, atorvastatin, to form S-ntrosylated and thereby modify this enzyme's activity metabolize n-3 DPA to form a 13"R"-hydroperoxy-n-3 DPA intermediate which is passed over to nearby human neutrophils; these cell then metabolize the intermediate to four poly-hydroxyl metabolites termed resolvin T1 (RvT1), RvT2, RvT3, and RvT4. (The chirality of their hydroxyl residues has not yet been determined.) These T series resolvins also form in mice undergoing experimental inflammatory responses and have potent in vitro and in vivo anti-inflammatory activity; they are particularly effective in reducing the systemic inflammation as well as increasing the survival of mice injected with lethal doses of E. coli bacteria. Another set of newly described n-3 DPA resolvins, RvD1n-3, RvD2n-3, and RvD5n-3, have been named based on their presumed structural analogies to the DHS-derived resolvins RvD1, RvD2, and RvD5, respectively. These three n-3 DPA-derived resolvins have not been defined with respect to the chirality of their hydroxyl residues or the Cis–trans isomerism of their double bonds but do possess potent anti-inflammatory activity in animal models and human cells; they also have protective actions in increasing the survival of mice subjected to E. coli sepsis. The following table lists the structural formulae (DPA stands for docosapentaenoic acid), major activities, cellular receptor targets (where known), and Wikipedia pages giving further information on the activity and syntheses.
Protectins/neuroprotectins.
DHA-derived protectins/neuroprotectins.
Cells metabolize DHA by either ALOX15, by a bacterial or mammalian cytochrome P450 monooxygenase (Cyp1a1, Cyp1a2, or Cyp1b1 in mice; see CYP450#CYP families in humans and CYP450#animals) or by aspirin-treated cyclooxygenase-2 to 17"S"-hydroperoxy or 17"R"-hydroperoxy intermediates (see previous subsection); this intermediate is then converted to a 16"S",17"S"-epoxide which is then hydrolyzed (probably by a soluble epoxide hydrolase to protectin D1 (PD1, also termed neuroprotectin D1 [NPD1] when formed in neural tissue). PDX is formed by the metabolism of DHA by two serial lipoxygenases, probably a 15-lipoxygenase and ALOX12. 22-Hydroxy-PD1 (also termed 22-hydroxy-NPD1) is formed by the Omega oxidation of PD1 probably by an unidentified cytochrome P450 enzyme. While omega-oxidation products of most bioactive PUFA metabolites are far weaker than their precursors, 22-hydroxy-PD1 is as potent as PD1 in inflammatory assays. Aspirin-triggered-PD1 (AT-PD1 or AP-NPD1) is the 17"R"-hydroxyl diastereomer of PD1 formed by the initial metabolism of DHA by aspirin-treated COX-2 or possibly a cytochrome P450 enzyme to 17"R"-hydroxy-DHA and its subsequent metabolism possibly in manner similar to that which forms PD1. 10-Epi-PD1 (ent-AT-NPD1), the 10"S"-hydroxy diastereomer of PD1, has been detected in small amounts in human neutrophils. While its in vivo synthetic pathway has not been defined, 10-epi-PD1 has anti-inflammatory activity. The following table lists the structural formulae (DHA stands for docosahexaenoic acid), major activities, cellular receptor targets (where known), and Wikipedia pages giving further information on the activity and syntheses.
n-3 DPA-derived protectins/neuroprotectins.
n-3 DPA-derived protectins with structural similarities to PD1 and PD2 have been described, determined to be formed in vitro and in animal models, and termed PD1n-3 and PD2n-3, respectively. These products are presumed to be formed in mammals by the metabolism of n-3 DPA by an unidentified 15-lipoxygenase activity to 16,17-epoxide intermediate and the subsequent conversion of this intermediate to the di-hydroxyl products PD1n-3 and PD2n-3. PD1n-3 has anti-inflammatory activity in a mouse model of peritonitis; PD2n-3 has anti-inflammatory activity in an in vitro model. The following table lists the structural formulae (DPA stands for docosapentaenoic acid), major activities, cellular receptor targets (where known), and Wikipedia pages giving further information on the activity and syntheses.
Maresins.
DHA-derived maresins.
Cells metabolize DHA by ALOX12, other lipoxygenase, (12/15-lipoxygenase in mice), or an unidentified pathway to a 13"S",14"S"-epoxide-4"Z",7"Z",9"E",11"E",16"Z",19"Z"-DHA intermediate (13"S",14"S"-epoxy-marisin MaR) and then hydrolyze this intermediate by an epoxide hydrolase activity (which ALOX 12 and mouse 12/15-lipoxygenase possess) to MaR1 and MaR2. During this metabolism, cells also form 7-epi-Mar1, i.e. the 7"S"-12"E" isomer of Mar1, as well as the 14"S"-hydroxy and 14"R"-hydroxy metabolites of DHA. The latter hydroxy metabolites can be converted by an unidentified cytochrome P450 enzyme to maresin like-1 (Mar-L1) and Mar-L2 by omega oxidation; alternatively, DHA may be first metabolized to 22-hydroxy-DHA by CYP1A2, CYP2C8, CYP2C9, CYP2D6, CYP2E1, or CYP3A4 and then metabolized through the cited epoxide-forming pathways to Mar-L1 and MaR-L2. Studies have found that these metabolites have potent anti-inflammatory activity in vitro and in animal models. The following table lists the structural formulae (DHA stands for docosahexaenoic acid), major activities, cellular receptor targets (where known), and Wikipedia pages giving further information on the activity and syntheses.
n-3 DPA-derived maresins.
n-3 DPA-derived maresins are presumed to be formed in mammals by metabolism of n-3 DPA by an undefined 12-lipoxygenase activity to a 14-hydroperoxy-DPA intermediated and the subsequent conversion of this intermediate to di-hydroxyl products which have been termed MaR1n-3, MaR2n-3, and MaR3n-3 based on their structural analogies to MaR1, MaR2, and MaR3, respectively. MaR1n-3 and MaRn-3 have been found to possess anti-inflammatory activity in in vitro assays of human neutrophil function. These n-3 DPA-derived maresins have not been defined with respect to the chirality of their hydroxyl residues or the cis–trans isomerism of their double bonds. The following table lists the structural formulae (DPA stands for docosapentaenoic acid), major activities, cellular receptor targets (where known), and Wikipedia pages giving further information on the activity and syntheses.
Other PUFA metabolites with SPM-like activity.
The following PUFA metabolites, while not yet formally classified as SPM, have been recently described and determined to have anti-inflammatory activity.
n-3 DPA metabolites.
10"R",17"S"-dihydroxy-7"Z",11"E",13"E",15"Z",19"Z"-docosapentaenoic acid (10"R",17"S"-diHDPAEEZ) has been found in inflamed exudates of animal models and possesses in vitro and in vivo anti-inflammatory activity almost as potently as PD1.
n-6-DPA metabolites.
n-6 DPA (i.e. 4"Z",7"Z",10"Z",13"Z",16"Z"-docosapentaenoic acid or osbond acid) is an isomer of n-3 DPA (clupanodonic acid) differing form the latter fatty acid only in the location of its 5 double bonds. Cells metabolize n-6 DPA to 7-hydroxy-DPAn-6, 10,17-dihydroxy-DPAn-6, and 7,17-dihydroxy-DPAn-3; the former two metabolites have been shown to possess anti-inflammatory activity in in vitro and in animal model studies.
oxo-DHA and oxo-DPA metabolites.
Cells metabolize DHA and n-3 DPA by COX2 to 13-hydroxy-DHA and 13-hydroxy-DPAn-3 products and by aspirin-treated COX2 to 17-hydroxy-DHA and 17-hydroxy-DPAn-3 products and may then oxidize these products to there corresponding oxo (i.e. ketone) derivatives, 13-oxo-DHA (also termed electrophilic fatty acid oxo derivative or EFOX-D6), 13-oxo-DPAn-3 (EFOX-D5), 17-oxo-DHA (17-EFOX-D6), and 17-oxo-DPAn-3 (17-EFOX-D3). These oxo metabolites directly activate the nuclear receptor Peroxisome proliferator-activated receptor gamma and possess anti-inflammatory activity as assesses in in vitro systems.
Docosahexaenoyl ethanolamide metabolites.
DHA ethanolamide ester (the DHA analog of arachindonyl ethanolamide [i.e. Anandamide]) is metabolized to 10,17-dihydroxydocosahexaenoyl ethanolamide (10,17-diHDHEA) and/or 15-hydroxy-16(17)-epoxy-docosapentaenoyl ethanolamide (15-HEDPEA) by mouse brain tissue and human neutrophils. Both compounds possess anti-inflammatory activity in vitro; 15-HEDPEA also has tissue-protective effects in mouse models of lung injury and tissue reperfusion. Like anandamide, both compounds activated the Cannabinoid receptor.
Prostaglandins and isoprostanes.
PUFA derivatives containing a Cyclopentenone structure are chemically reactive and can form adducts with various tissue targets, particularly proteins. Certain of these PUFA-cyclopentenones 
bind to the sulfur residues in the KEAP1 component of the KEAP1-NFE2L2 protein complex in the cytosol of cells. This negates KEAP1's ability to bind NFE2L2; in consequence, NFE2L2 becomes free to translocate to the nuclease and stimulate the transcription of genes that encode proteins active in detoxifying reactive oxygen species; this effect tends to reduce inflammatory reactions. PUFA-cyclopentenones may likewise react with the IKK2 component of the cytosolic IKK2-NFκB protein complex thereby inhibiting NFκB from stimulating the transcription of genes that encode various pro-inflammatory proteins. One or both of these mechanisms appears to contribute to the ability of certain highly reactive PUFA-cyclopenetenones to exhibit SPM activity. The PUFA-cyclopentenones include two prostaglandins, (PG) Δ12-PGJ2 and 15-deoxy-Δ12,14-PGJ2, and two isoprostanes, 5,6-epoxyisoprostane E2 and 5,6-epoxyisoprostane A2. Both PGJ2's are arachidonic acid-derived metabolites made by cyclooxygenases, primarily COX-2, which is induced in many cell types during inflammation. Both isoprostanes form non-enzymatically as a result the attack on the arachidonic acid bond to cellular phospholipids by reactive oxygen species; they are then release from the phospholipids to become free in attacking their target proteins. All four products have been shown to form and possess SPM activity in various in vitro studies of human and animal tissue as well as in in vivo studies of animal models of inflammation; they have been termed pro-resolving mediators of inflammation
Gene manipulation studies.
Mice made deficient in their 12/15-lipoxygenase gene (Alox15) exhibit a prolonged inflammatory response along with various other aspects of a pathologically enhanced inflammatory response in experimental models of cornea injury, airway inflammation, and peritonitis. These mice also show an accelerated rate of progression of atherosclerosis whereas mice made to overexpress 12/15-lipoxygenase exhibit a delayed rate of atherosclerosis development. Alox15 overexpressing rabbits exhibited reduced tissue destruction and bone loss in a model of periodontitis. Similarly, Alox5 deficient mice exhibit a worsened inflammatory component, failure to resolve, and/or decrease in survival in experimental models of respiratory syncytial virus disease, Lyme disease, Toxoplasma gondii disease, and corneal injury. These studies indicate that the suppression of inflammation is a major function of 12/15-lipoxygenase and Alox5 along with the SPMs they make in at least certain rodent experimental inflammation models; although these rodent lipoxygenases differ from human ALOX15 and ALOX5 in the profile of the PUFA metabolites that they make as well as various other parameters (e.g. tissue distribution), these genetic studies allow that human ALOX15, ALOX5, and the SPMs they make may play a similar anti-inflammatory functions in humans.
Concurrent knockout of the three members of the CYP1 family of Cytochrome P450 enzymes in mice, i.e. Cyp1a1, Cyp1a2, and Cyp1b1, caused an increase in the recruitment of neutrophils to the peritoneum in mice undergoing experimental peritonitis; these triple knockout mice also exhibited an increase in the peritoneal fluid LTB4 level and decreases in the levels of peritoneal fluid NPD1 as well as the precursors to various SPMS including 5-hydroxyeicosatetraenoic acid, 15-Hydroxyeicosatetraenoic acid, 18-hydroxyeicosapentaenoic acid, 17-hydroxydocosahexaenoic acid, and 14-hydroxydocosahexaenoic. These results support the notion that Cyp1 enzymes contribute to the production of certain SPMs and inflammatory responses in mice; CYP1 enzymes may therefore play a similar role in humans.
Clinical studies.
In a randomized controlled trial, AT-LXA4 and a comparatively stable analog of LXB4, 15"R/S"-methyl-LXB4, reduced the severity of eczema in a study of 60 infants. A synthetic analog of ReV1 is in clinical phase III testing (see Phases of clinical research) for the treatment of the inflammation-based dry eyesyndrome; along with this study, other clinical trials (NCT01639846, NCT01675570, NCT00799552 and NCT02329743) using an RvE1 analogue to treat various ocular conditions are underway. RvE1, Mar1, and NPD1 are in clinical development studies for the treatment of neurodegenerative diseases and hearing loss. And, in a single study, inhaled LXA4 decreased LTC4-initiated bronchoprovocation in patients with asthma.