Heterogeneous causes of acute respiratory distress syndrome correlate with distinct peripheral polyunsaturated fatty acid metabolites

Acute Respiratory Distress Syndrome (ARDS), a heterogeneous syndrome of hypoxic respiratory failure secondary to dysregulated pulmonary inflammation, is caused by diverse insults. Because of this heterogeneity, mechanisms and treatments are difficult to study. As a treatment, n-3 polyunsaturated fatty acid (PUFA) supplementation has had mixed results. PUFAs and downstream oxylipins are important to pulmonary inflammation but are not well defined in ARDS. We hypothesized that differences in fatty acid metabolism, as measured by levels of n-3 and n-6 PUFAs and oxylipins, are associated with differences in ARDS outcomes, ARDS causes, and inflammation. To test this, PUFAs/oxylipins were measured by LC MS/MS in plasma samples from 90 patients with ARDS. Inflammatory cytokines (IL-6, IL-8) were measured by ELISA. Multivariate linear regressions modeled the relationship between PUFAs/oxylipins, inflammation, and ARDS mortality, severity and cause. Multiple n-3 and n-6 PUFA derived oxylipins were decreased in severe ARDS. We did not detect differences in PUFAs/oxylipins by mortality. PUFAs/oxylipins varied by cause of ARDS, especially between patients with sepsis and those with trauma. Furthermore, specific oxylipins were associated with IL-6 and IL-8. Based on our identification of oxylipins that vary by disease severity and injury, these metabolites should be considered as potential biomarkers and mechanisms of lung repair biomarkers. Furthermore, differences in PUFAs did not directly correlate with changes in oxylipins, suggesting differences in lipid metabolism by etiology of injury. Further consideration of differences in lipid metabolism in ARDS could identify potential subgroups that could benefit from n-3 PUFA supplementation or other therapies.