Inappropriate, excessive or uncontrolled inflammation contributes to a wide range of human diseases.¹ Natural healthcare practitioners respond to this clinical challenge by harnessing the anti-inflammatory and inflammation resolving actions of omega-3 fatty acids.

Despite growing public awareness of their importance, a surprisingly small 20% of Australians meet the recommended intake of omega-3s required for optimal health.² In addition to increasing dietary sources, supplemental Fish Oil and Algal Oil are a treatment priority for many patients to improve omega-3 levels, manage inflammation, and support health and wellbeing.

Specialised pro-resolving mediators (SPMs) are an innovative form of omega-3. What are they and how are they prescribed clinically compared to Fish Oil and Algal Oil?

What are SPMs?

SPMs are bioactive lipid mediators derived from polyunsaturated fatty acids. The SPMs resolvins, protectins and maresins are derived from eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), while lipoxins come from omega-6. SPMs are naturally produced in the body, and can also be supplemented as an SPM-enriched fish oil.

SPM concentrations appear to be disordered in many inflammatory conditions.^3,4,5 SPMs help reduce chronic pain and inflammation by actively promoting resolution of the inflammatory response.⁶ Recognised as ‘immunoresolvents’,⁷ SPMs help direct and control the inflammatory response. They restrain chronic inflammation by counter-regulating pro-inflammatory mediators, reducing the magnitude and duration of inflammation, and stimulating wound healing and tissue regeneration.⁸ SPMs also enhance microbial killing and clearance, promote host-protective actions in infections, limit collateral tissue damage and fibrosis, and reduce pain.⁹

SPMs Reduce Pain and Inflammation and Promote Healing

In adults with moderate to severe chronic pain (≥ 3 months), supplementation with SPM-enriched marine lipids for 4 weeks led to significant positive changes in pain intensity, fatigue, sleep disturbance, mood, and physical and social functioning, compared to baseline.¹⁰ In a randomised, controlled trial of patients with symptomatic knee osteoarthritis (n=51), supplementation with SPM-enriched oil led to statistically significant reductions in pain scores after 8 weeks compared to placebo, with greater reductions seen after 12 weeks of SPM treatment.¹¹

Clinical applications of SPMs include:

• Conditions with chronic and unresolved inflammation (e.g. chronic pain, autoimmunity, arthritis, neuroinflammatory conditions, persistent injuries)
• Post-injury or post-surgery recovery
• Chronic immune dysregulation (e.g. long COVID, chronic infection)
• Obesity-related metabolic conditions, cardiovascular disease, cancer-associated inflammation, skin conditions, other inflammatory chronic diseases

Therapeutic Benefits of Fish Oil

Fish Oil is a concentrated source of omega-3 fatty acids, particularly EPA and DHA. As well as reducing inflammation, marine derived omega-3s play important roles in supporting cardiovascular health, brain function and cognition, eye health, and growth and development.¹² Omega-3s reduced joint pain intensity, morning stiffness, and number of painful and/or tender joints in patients with rheumatoid arthritis.¹³

Omega-3 supplementation is also important during pregnancy, reducing the risk of pre-term birth and having lasting effects on brain structure and function in the growing child.^14,15 With benefits at all stages of life, omega-3 (2,800 mg/day) improved mood and attention in healthy adults¹⁶ and may slow memory decline in those at risk of Alzheimer’s disease.¹⁷

Clinical applications of Fish Oil include:

• General anti-inflammatory support (joint pain, metabolic health)
• Maintaining healthy blood lipids (lowering triglycerides and cholesterol)
• Maintaining cardiovascular system health and heart health
• Cognition and brain function
• Supporting healthy pregnancy and development
• General health and wellbeing

The Algal Oil Alternative

Omega-3 deficiency can occur in vegans and vegetarians, people with seafood allergies and those who avoid eating fish.¹⁸ Although fish are the main dietary source, omega-3s are originally produced by microalgae rather than fish, making Algal Oil a viable alternative.^19,20 Algal Oil (from Schizochytrium sp.) provides a rich plant-based source of omega-3s, especially DHA²¹ for a vegan, low allergen option.

Microalgae DHA (2,110 mg/day) ameliorated disease activity (tender and swollen joints) in rheumatoid arthritis patients and shifted the balance of arachidonic acid- and DHA-derived lipid mediators towards an anti-inflammatory/pro-resolving state (alongside regular medication).²²

Clinical applications of Algal oil include:

• General anti-inflammatory support
• Cardiovascular system health and function
• Maintaining healthy blood lipids
• Brain health and cognitive function
• Healthy eyesight and retina health
• Nervous system function
• General health and wellbeing

In Summary

Targeting inappropriate, excessive or unresolved inflammation is an important clinical strategy in treating a wide range of health conditions. The advantage of SPMs lies in their ability to turn off the switch on inflammation, while Fish Oil and Algal Oil optimise omega-3 levels throughout life.

References

1. Calder PC. Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochem Soc Trans. 2017 Oct 15;45(5):1105-1115. DOI: 10.1042/BST20160474
2. Yeiser M, et al. Growth and tolerance of infants fed formula with a new algal source of docosahexaenoic acid: double-blind, randomized, controlled trial. Prostaglandins Leukot Essent Fatty Acids. 2016 Dec;115:89-96. 
3. Dalli J, Gomez EA, Jouvene CC. Utility of the specialized pro-resolving mediators as diagnostic and prognostic biomarkers in disease. Biomolecules. 2022 Feb;12(3):353. DOI: 10.3390/biom12030353
4. Kooij G, Troletti CD, Leuti A, Norris PC, Riley I, Albanese M, et al. Specialized pro-resolving lipid mediators are differentially altered in peripheral blood of patients with multiple sclerosis and attenuate monocyte and blood-brain barrier dysfunction. Haematologica. 2020 Aug;105(8):2056-2070. DOI: 10.3324/haematol.2019.219519
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7. Basil MC, Levy BD. Specialized pro-resolving mediators: endogenous regulators of infection and inflammation. Nat Rev Immunol. 2016 Jan;16(1):51-67. DOI: 10.1038/nri.2015.4
8. Serhan CN. Pro-resolving lipid mediators are leads for resolution physiology. Nature. 2014 Jun;510(7503):92-101. DOI: 10.1038/nature13479
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10. Callan N, Hanes D, Bradley R. Early evidence of efficacy for orally administered SPM-enriched marine lipid fraction on quality of life and pain in a sample of adults with chronic pain. J Transl Med. 2020 Oct;18(1):401. DOI: 10.1186/s12967-020-02569-5
11. Möller I, Rodas G, Villalón JM, Rodas JA, Angulo F, Martínez N, et al. Randomized, double-blind, placebo-controlled study to evaluate the effect of treatment with an SPMs-enriched oil on chronic pain and inflammation, functionality, and quality of life in patients with symptomatic knee osteoarthritis: GAUDI study. J Transl Med. 2023 Jun;21(1):423. DOI: 10.1186/s12967-023-04283-4
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15. Lepping RJ, et al. Long-chain polyunsaturated fatty acid supplementation in the first year of life affects brain function, structure, and metabolism at age nine years. Dev Psychobiol. 2019 Jan;61(1):5-16.
16. Fontani G, et al. Cognitive and physiological effects of omega-3 polyunsaturated fatty acid supplementation in healthy subjects. Eur J Clin Invest. 2005 Nov;35(11):691-699.
17. Yassine HN, Braskie MN, Mack WJ, Castor KJ, Fonteh AN, Schneider LS, et al. Association of docosahexaenoic acid supplementation with Alzheimer disease stage in apolipoprotein e ε4 carriers: a review. JAMA Neurol. 2017 Mar;74(3):339-347. DOI: 10.1001/jamaneurol.2016.4899
18. Burdge GC, et al. Long-chain n-3 PUFA in vegetarian women: a metabolic perspective. J Nutr Sci. 2017;6:e58.
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