TREATING CYSTIC FIBROSIS WITH FISH OIL

Abstract

14 July 2004 Dear Editor, In 1997, I published the results of a small open study reporting the beneficial effect of omega 3 fatty acid (eicosopentanoic acid-fish oil) supplements in the management of children with cystic fibrosis (CF) and chronic lung disease1. One of the five subjects had severe disease and died during the study, and her parameters effectively cancelled the positive effects of the other four, thus distracting from the impact of the potential of this therapy. Now, Karp et al. have demonstrated that the major problem in CF airways is the inability to produce lipoxins, anti-inflammatory mediators, which results in an exaggerated pro inflammatory propensity, up-regulating neutrophil response and in turn contributing to persistence of pseudomonas aeruginosa infection2. In laboratory experiments using human bronchial epithelial cells, and also a CF mouse model, all of these changes were reversed by adding lipoxins. Another class of anti-inflammatory lipid mediators, ‘resolvins’, share many of the biological activities of lipoxins. These resolvins are generated from omega 3 fatty acids, and their levels are determined by substrate availability3. Patients with CF, and cystic fibrosis transport regulator (CFTR) -/- mice show deficiencies in omega 3 fatty acids in tissues expressing CFTR4. Thus, supplementing omega 3 fatty acids may increase resolvins and thence reduce inflammation and pseudomonas aeruginosa bacterial load. These reports add a strong basis to the practical application of using omega 3 fatty acids to reduce chronic airway inflammation in CF, and hopefully will encourage a controlled trial of this relatively cheap, neglected and harmless intervention.