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Mechanisms of Disease: leukotrienes and lipoxins in scleroderma lung disease—insights and potential therapeutic implications

Nature Clinical Practice Rheumatology volume 3, pages 43–51 (2007)Cite this article

Abstract

Scleroderma interstitial lung disease (SLD) is a leading cause of morbidity and mortality in patients with systemic sclerosis. Although the pathogenesis of SLD is not clear, excessive fibrosis and inflammatory cell infiltration are the main histologic features of this disorder. Leukotrienes and lipoxins are two functionally different classes of lipoxygenase-derived eicosanoids. Leukotrienes are potent proinflammatory mediators and directly and indirectly stimulate fibroblast chemotaxis, proliferation, and collagen synthesis. Lipoxins counter-regulate the proinflammatory actions of leukotrienes and activate resolution of the inflammatory response. In addition, lipoxins inhibit growth-factor-induced fibroblast proliferation and collagen synthesis. Studies using bronchoalveolar lavage have revealed that there is an overproduction of proinflammatory and profibrotic leukotrienes in the lungs of patients with SLD, and that leukotriene levels correlate with inflammatory indices within the lungs. Moreover, the increased levels of leukotrienes in these patients are not balanced by an upregulation of anti-inflammatory and antifibrotic lipoxins. Unopposed actions of leukotrienes might, therefore, induce chronic inflammation and fibrosis in the lungs of SLD patients. Accordingly, pharmacologic correction of a leukotriene–lipoxin imbalance using leukotriene inhibitors or lipoxin analogs might be a new approach to the treatment of SLD.

Key Points

  • Fibrosis and chronic inflammation are main histologic features of scleroderma interstitial lung disease (SLD), which is a leading cause of morbidity and mortality in patients with systemic sclerosis

  • Increased levels of proinflammatory and profibrotic leukotrienes are found in the lungs of patients with SLD

  • The levels of leukotrienes correlate with lower-respiratory-tract inflammation as estimated by cytologic analysis of bronchoalveolar lavage fluid

  • There is a relative deficiency of anti-inflammatory and antifibrotic lipoxins in the lungs of patients with SLD

  • Correction of the leukotriene–lipoxin imbalance might be a promising new approach for the treatment of patients with SLD

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Figure 1: The main pathways of the biosynthesis of leukotrienes, lipoxins and 15-epimeric-lipoxins.
Figure 2: The hypothetical role of lipoxygenase-derived leukotrienes and lipoxins in the pathogenesis of scleroderma interstitial lung disease.
Figure 3: Levels of lipoxygenase-derived eicosanoids in bronchoalveolar lavage fluids of controls and SSc patients with or without SLD.

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Acknowledgements

This work was supported in part by a grant from the Polish State Committee for Scientific Research to O Kowal-Bielecka.

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Authors and Affiliations

  1. O Kowal-Bielecka is a Senior Fellow in the Department of Rheumatology and Internal Medicine, and K Kowal is a Senior Fellow in the Department of Allergology and Internal Medicine, Medical University in Bialystok, Bialystok, Poland.,

    Otylia Kowal-Bielecka & Krzysztof Kowal

  2. O Distler is a Senior Fellow in the Department of Rheumatology and a Research-Group Leader at the Center of Experimental Rheumatology, University Hospital, Zürich, Switzerland,

    Oliver Distler

  3. S Gay is Director of the WHO Collaborating Center for Molecular Biology and Novel Therapeutic Strategies for Rheumatic Diseases.,

    Steffen Gay

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  1. Otylia Kowal-Bielecka
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Correspondence to Otylia Kowal-Bielecka.

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Kowal-Bielecka, O., Kowal, K., Distler, O. et al. Mechanisms of Disease: leukotrienes and lipoxins in scleroderma lung disease—insights and potential therapeutic implications. Nat Rev Rheumatol 3, 43–51 (2007). https://doi.org/10.1038/ncprheum0375

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