It has been suggested that
aspirin may be of benefit in treating
sepsis and ARDS in view of its ability to block cyclo-oxygenase-1 (COX-1) and COX-2 activities; inhibit
nuclear factor kappa B (NF-κB); enhance the production of endothelial
nitric oxide (eNO) and
lipoxin A4 (
LXA4). Our previous studies revealed that plasma
phospholipid content of
arachidonic acid (AA) and
eicosapentaenoic acid (EPA) is low in patients with
sepsis. This implies that beneficial actions of
aspirin in
sepsis and ARDS is unlikely to be obtained in view of deficiency of AA and EPA, the precursors of
LXA4 and resolvins respectively that are potent anti-inflammatory compounds and enhancers of eNO generation. In view of this, I propose that a combination of
aspirin and AA and EPA (and possibly,
docosahexaenoic acid, DHA) is likely to be superior in the management of
sepsis and ARDS compared to
aspirin alone. This suggestion is supported by the recent observation that
trauma patients with uncomplicated recoveries had higher resolvin pathway gene expression and lower gene expression ratios of
leukotriene: resolvin pathways.