Relationship of circulating hyaluronic acid levels to disease control in asthma and asthmatic pregnancy

PLoS One. 2014 Apr 15;9(4):e94678. doi: 10.1371/journal.pone.0094678. eCollection 2014.

Abstract

Uncontrolled asthma is a risk factor for pregnancy-related complications. Hyaluronic acid (HA), a potential peripheral blood marker of tissue fibrosis in various diseases, promotes eosinophil survival and plays a role in asthmatic airway inflammation as well as in physiological processes necessary to maintain normal pregnancy; however the level of circulating HA in asthma and asthmatic pregnancy is unknown. We investigated HA levels in asthmatic patients (N = 52; asthmatic pregnant (AP) N = 16; asthmatic non-pregnant (ANP) N = 36) and tested their relationship to asthma control. Serum HA level was lower in AP than in ANP patients (27 [24.7-31.55] vs. 37.4 [30.1-66.55] ng/mL, p = 0.006); the difference attenuated to a trend after its adjustment for patients' age (p = 0.056). HA levels and airway resistance were positively (r = 0.467, p = 0.004), HA levels and Asthma Control Test (ACT) total score inversely (r = -0.437, p = 0.01) associated in ANP patients; these relationships remained significant even after their adjustments for age. The potential value of HA in the determination of asthma control was analyzed using ROC analysis which revealed that HA values discriminate patients with ACT total score ≥20 (controlled patients) and <20 (uncontrolled patients) with a 0.826 efficacy (AUC, 95% CI: 0.69-0.97, p = 0.001) when 37.4 ng/mL is used as cut-off value in ANP group, and with 0.78 efficacy (AUC, 95% CI: 0.65-0.92, p = 0.0009) in the whole asthmatic cohort. In conclusion circulating HA might be a marker of asthma control, as it correlates with airway resistance and has good sensitivity in the detection of impaired asthma control. Decrease of HA level in pregnancy may be the consequence of pregnancy induced immune tolerance.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Asthma / blood*
  • Asthma / therapy
  • Female
  • Humans
  • Hyaluronic Acid / blood*
  • Pregnancy
  • Pregnancy Complications / blood*
  • Pregnancy Complications / therapy
  • ROC Curve

Substances

  • Hyaluronic Acid

Grants and funding

This work was supported by the Hungarian Scientific Research Fund [OTKA; grant number K109008 to G. L.; Web site: http://www.otka.hu/] and by a Hungarian Respiratory Society grant (to N. E.; Web site: http://www.tudogyogyasz.hu/). The research was also supported by the European Union and the State of Hungary, co-financed by the European Social Fund in the framework of TÁMOP 4.2.4. A/2-11-1-2012-0001 ‘National Excellence Program’ (to G. T.; Web site: http://kih.gov.hu/nemzeti). G. T. is an International Society for the Advancement of Cytometry (ISAC) Scholar (Web site: http://isac-net.org/). The funding sources had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.