Is Ibuprofen the Secret to Cystic Fibrosis Treatment?
The drug that works wonders for so many other everyday ailments could be a key component in future treatments of cystic fibrosis patients.
Scientists say yes. The drug that works wonders for so many other everyday ailments could be a key component in the future treatments of cystic fibrosis patients. It’s hard to imagine that a drug found in nearly everyone's medicine cabinet could be a crucial component in the treatment of cystic fibrosis patients. How exactly does Ibuprofen work on CF? What exactly does this breakthrough mean for the future of cystic fibrosis treatment?
Ibuprofen: The basics
As one of the world's most popular painkillers, Ibuprofen was discovered almost by accident. Dr. Stewart Adams had a hangover one morning after a night out with friends, but before an important speech was to be given. In a moment of desperation, Dr. Adams took the drug he had been researching, now known as Ibuprofen, and was pleased to discover how well it worked. Dr. Adams stated, "I was first up to speak and I had a bit of a headache after a night out with friends. So I took a 600mg dose, just to be sure, and I found it was very effective."
Understanding the basic pharmacology behind ibuprofen is the key to understanding how exactly it benefits CF patients. Ibuprofen works to reduce pain by targeting compounds within the inflammatory response known as prostaglandins. Targeting these compounds lessens inflammation, which is the root of most pain. Inflammation causes redness, swelling, tenderness, loss of function, fever, and pain, and can take an incredibly negative toll on the body. In the most simplified definition, ibuprofen is an anti-inflammatory drug that is non steroidal and can be used to safely treat pain and fever. Although considered on of the safest NSAIDS (Non-Steroidal Anti Inflammatory Drug) in low doses, higher doses can put patients at a high risk of developing stomach ulcers and bleeding. Ibuprofen is effective in reducing pain associated with toothaches, cold and flu symptoms, headaches, menstrual cramps, and arthritis symptoms. Ibuprofen dosage ranges from 200 mg-800 mg for over the counter, and 1200 mg to 1600 mg for prescription strength.
Higher doses of the drug are also known to heighten the risk of heart disease and stroke while also negatively affecting the blood's ability to clot. Higher doses are generally only prescribed by a physician for someone with chronic pain or an illness that benefits from ibuprofen.
Ibuprofen and CF patients
So, how exactly does this benefit someone with CF? Researchers published this study: “Antimicrobial Activity of Ibuprofen against Cystic Fibrosis-Associated Gram-Negative Pathogens,” in the journal Antimicrobial Agents and Chemotherapy. This study provided evidence that ibuprofen reduces the biofilm regeneration on the lungs. Adult patients in the study who received ibuprofen in high doses saw improvement in lung function decline and pulmonary functioning in general. The antiinflammatory properties are the reasons behind these beneficial effects, but scientists also studied the potential antimicrobial effects as well.
Past studies have shown that Ibuprofen is effective in delaying the regeneration of biofilm on the lungs. Researchers performed the study on several types of two bacteria; Pseudomonas aeruginosa and Burkholderia. What they discovered was a dose-dependent decrease of both bacteria in the span of 12 hours. Initially, Burkholderia was impacted the greatest after the 12 hours, but after another dose, the bacterial regrowth continued to be suppressed for the Pseudomonas aeruginosa as well.
In addition to both anti-inflammatory testing and anti-microbial testing, researchers also tested anti-bacterial effects while using the drug. When delivered orally, the drug reduced the bacteria in both the lungs and spleen, an exciting discovery.
Because of Ibuprofen’s notoriously dangerous side effects in patients ingesting it at high doses, there hasn’t been a significant push to add Ibuprofen to a cystic fibrosis patient’s treatment program. Cystic fibrosis patients’ immune systems are already overburdened, and since high doses of Ibuprofen have been linked to gastrointestinal hemorrhaging and kidney toxicity, the benefit may not outweigh the risk.
Creating an Ibuprofen aerosol
Scientists understand the dangerous effects Ibuprofen can have when taken in high doses, which is why these same scientists created an aerosol form specifically for cystic fibrosis patients. In its aerosol form, the drug can work in a more localized fashion without being ingested into the gastrointestinal tract and metabolized in the liver and spleen. This aerosol form is a high dose, making it effective in its antimicrobial, anti-inflammatory, and anti-bacterial properties.
Carolyn Cannon, a professor at A&M Health Science Center College of Medicine, speaks highly of the Ibuprofen aerosol and its potential benefit to cystic fibrosis patients. Cannon states that “nanoparticle ibuprofen delivered by aerosol to the lungs would be a fantastic therapeutic, and because it is essentially a repurposed drug—only the delivery method is different—the development and regulatory approval process should be relatively easy, in comparison to the requirements for a novel therapeutic.”
She added, “The researchers who performed the original ibuprofen study thought it was working solely by inhibiting the migration of a type of white blood cell, called the neutrophil, to the lung. It goes hand-in-hand with acute inflammation, However, although this may be one mechanism of action, at the high doses that were being given to the cystic fibrosis patients, the drug also has antimicrobial properties.”
Aerosol ibuprofen has been tested in rats and other animal models with pneumonia, because pneumonic fluid is a similar consistency to cystic fibrosis fluid. The animal models were administered aerosol Ibuprofen alongside antibiotics to lessen the spread of cystic fibrosis in the lungs, and it was highly effective. Animal models experienced a lower rate of microbial regrowth and a noticeable difference in lung function. The lungs did not decline in function as fast which resulted in a higher quality of life for a longer period of time in between treatments.
Final thoughts
Ibuprofen is used to relieve pain from various conditions such as headache, dental pain, menstrual cramps, muscle aches, or arthritis. It is also used to reduce fever and to relieve minor aches and pain due to the common cold or flu. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). Could it really be possible that this medicine cabinet staple can make such an incredible impact on cystic fibrosis patients? We just may be on our way.
Although research is still ongoing and testing is being done at various research facilities throughout the world, scientists remain optimistic that Ibuprofen in aerosol form will be introduced as a normal medicine in cystic fibrosis treatment. Taking into account the importance of Ibuprofen being administered in aerosol form as opposed to orally, due to the high risk of negative side effects, researchers note that this could be a game changer for many other chronic conditions as well.
Patients who are stricken with pneumonia or other severe viruses that cause difficulty breathing due to inflammation and airway constriction could benefit from this new administration. Other respiratory illnesses and infections could be reduced in severity with the use of aerosol Ibuprofen in hospitals and other healthcare settings.
Looking toward the future, researchers say we should expect to see aerosol Ibuprofen prescribed to cystic fibrosis patients to aid in treatment, which is exciting news for suffers and caregivers alike. Lessening inflammation for cystic fibrosis patients will provide a higher quality of life for patients and peace of mind for caregivers.
References
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191627/
https://www.webmd.com/drugs/2/drug-5166-9368/ibuprofen-oral/ibuprofen-oral/details
https://vitalrecord.tamhsc.edu/inhalable-ibuprofen-on-horizon/?_ga=1.41368418.1970276986.1481819444
http://www.bbc.com/news/health-34798438
