Lipoxin A4 levels in asthma:: relation with disease severity and aspirin sensitivity

Background Lipoxin (LX) A(4), an endogenous anti-inflammatory eicosanoid, has been found to be low in patients with severe asthma. However, few studies also suggested more diminished LX A(4) levels in aspirin-exacerbated respiratory disease (AERD) when compared with aspirin-tolerant asthma (ATA). It is, therefore, currently not clear whether the asthma severity or the presence of AERD has a primary role in the disturbed LX metabolism. Objective To detect LX A(4) and 15-epi-LX A(4) levels in asthma patients with and without AERD of comparable severity. Methods The study groups consisted of 22 subjects with AERD, 22 subjects with ATA and 10 volunteers without asthma and aspirin sensitivity. Whole-blood samples were stimulated with calcium ionophore, A23187 (5 x 10(-5) M) and A23187 (5 x 10(-5) M)+aspirin (10(-4) M). LX A(4) and 15-epi-LX A(4) levels were analysed by the enzyme immune assay method. Results Severe asthma patients in both AERD [0.5 (0.8)] ng/mL and ATA [0.5 (0.45) ng/mL] groups showed diminished generation for LX A(4) to stimulation with A23187 in comparison with other severity degrees in their groups (P=0.02 and 0.046, respectively). LX A(4) generation in both severe groups was comparable with each other (P > 0.05). Although severe cases with AERD showed a diminished capacity to generate 15-epi-LX A(4), this did not reach statistical significance. Conclusion This study indicated that diminished LX A(4) generation was unique to severe asthma phenotype regardless of comorbid aspirin sensitivity. Lower LX A(4) levels in severe asthma would suggest a possibility for LX analogues as future treatment options in these patients.