Therapeutics for arachidonic acid pathways began with the development of non-steroidal anti-inflammatory drugs that inhibit cyclooxygenase (COX). The enzymatic pathways and arachidonic acid metabolites and respective receptors have been successfully targeted and therapeutics developed for pain, inflammation, pulmonary and cardiovascular diseases. These drugs target the COX and lipoxygenase pathways but not the third branch for arachidonic acid metabolism, the cytochrome P450 (CYP) pathway. Small molecule compounds targeting enzymes and CYP epoxy-fatty acid metabolites have evolved rapidly over the last two decades. These therapeutics have primarily focused on inhibiting soluble epoxide hydrolase (sEH) or agonist mimetics for epoxyeicosatrienoic acids (EET). Based on preclinical animal model studies and human studies, major therapeutic indications for these sEH inhibitors and EET mimics/analogs are renal and cardiovascular diseases. Novel small molecules that inhibit sEH have advanced to human clinical trials and demonstrate promise for cardiovascular diseases. Challenges remain for sEH inhibitor and EET analog drug development; however, there is a high likelihood that a drug that acts on this third branch of arachidonic acid metabolism will be utilized to treat a cardiovascular or kidney disease in the next decade.

花生四烯酸途径的治疗始于抑制环氧合酶（COX）的非甾体抗炎药的开发。酶促途径、花生四烯酸代谢物和各自的受体已成功针对疼痛、炎症、肺部和心血管疾病开发出治疗方法。这些药物靶向 COX 和脂氧合酶途径，但不是花生四烯酸代谢的第三个分支，即细胞色素 P450 (CYP) 途径。过去二十年来，针对酶和 CYP 环氧脂肪酸代谢物的小分子化合物发展迅速。这些疗法主要集中于抑制可溶性环氧化物水解酶（sEH）或环氧二十碳三烯酸（EET）的激动剂模拟物。根据临床前动物模型研究和人体研究，这些 sEH 抑制剂和 EET 模拟物/类似物的主要治疗适应症是肾脏和心血管疾病。抑制 sEH 的新型小分子已进入人体临床试验，并显示出治疗心血管疾病的前景。sEH 抑制剂和 EET 类似物药物开发仍面临挑战；然而，作用于花生四烯酸代谢第三个分支的药物很可能在未来十年内用于治疗心血管或肾脏疾病。