Electrophilic Fatty Acid Derivatives in Asthma

Relevant to asthma, the chemical identities and potent anti-inflammatory signaling actions
of endogenously-produced Electrophilic Fatty acid OXidation products (EFOXs) have recently
been described. Endogenous EFOXs include nitro and alpha and beta-unsaturated ketone
derivatives of unsaturated fatty acids that are generated as byproducts of a) fatty acid
oxidation and nitration by inflammatory-derived reactive species and b) enzymatic fatty acid
oxygenation reactions catalyzed by cyclooxygenase-2 and lipoxygenases. Recent data reveal
that multiple salutary post-translational protein modifications are induced by EFOXs.
Specifically, the covalent adduction of functionally-significant thiols in signaling
proteins occurs, with these reactions modulating critical inflammatory signaling pathways.
These signaling proteins include the nuclear lipid receptor PPARg and the redox-sensitive
transcription factors NF kappaB and Keap1/Nrf2. This proposed research investigates the
concept that the reversible reaction of EFOXs with critical transcription factors results in
the regulation of adaptive responses to inflammation.

In this clinical study, bronchoalveolar lavage fluid (BAL) will be obtained from asthmatics
treated with COX-2 inhibitors that enhance (aspirin) and inhibit (indomethacin) COX-2
dependent EFOX generation, as well as from those assigned to no intervention. BAL will be
obtained from healthy, non-smoking adults with controlled asthma having at least a 12%
increase in FEV1 after short-acting bronchodilator treatment or a positive methacholine
response (reduction in FEV1 ≥ 20% at or before 16 mg/ml). A total of 30 asthmatic subjects
will be randomized (10 per arm) to a) aspirin, b) indomethacin or c) no intervention groups

Inclusion Criteria:

- Diagnosis of mild to moderate asthma

- No evidence of a previous asthma exacerbation in the preceding 6 weeks (defined as
increased severity of respiratory symptoms requiring systemic steroids or escalation
of therapy; b) asthma control questionnaire (ACQ) score less than 1.

Exclusion Criteria:

- Diagnosis of severe asthma, vocal cord dysfunction, cystic fibrosis, COPD, CAD,
hypertension, diabetes or renal failure that is not well controlled

- Greater than 10 pack-year history of smoking;

- Stopped smoking less than 1 year prior to study,

- Taking any aspirin or other NSAIDS on the week prior to bronchoscopy,

- Taking omega-3 fatty acid supplements

- If a subject is currently taking an omega-3 fatty acid supplement and is interested
in the study, after a 30 day wash out, the participant can be re-screened and
evaluated for participation.

- Taking pioglitazone or rosiglitazone (synthetic thiazolidinedione PPARg ligands);

- other known pulmonary diseases;

- Inability to undergo bronchoscopy,

- Contraindications or allergy to aspirin or indomethacin,

- Asthmatics with known hypersensitivity to aspirin, and

- Steroid (systemic) dependent