title: Relationship of circulating hyaluronic acid levels to disease control in asthma and asthmatic pregnancy.
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.
authors.affiliation: Department of Pulmonology, Semmelweis University, Budapest, Hungary.
authors.forename: Noémi
authors.initials: N
authors.lastname: Eszes
authors.affiliation: 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary.
authors.forename: Gergely
authors.initials: G
authors.lastname: Toldi
authors.affiliation: Department of Pulmonology, Semmelweis University, Budapest, Hungary.
authors.forename: Anikó
authors.initials: A
authors.lastname: Bohács
authors.affiliation: Department of Pulmonology, Semmelweis University, Budapest, Hungary.
authors.forename: István
authors.initials: I
authors.lastname: Ivancsó
authors.affiliation: Department of Pulmonology, Semmelweis University, Budapest, Hungary.
authors.forename: Veronika
authors.initials: V
authors.lastname: Müller
authors.affiliation: 1st Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary.
authors.forename: János
authors.initials: J
authors.lastname: Rigó
authors.affiliation: Department of Pulmonology, Semmelweis University, Budapest, Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Losonczy
authors.affiliation: Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary; Research Group of Pediatrics and Nephrology, Hungarian Academy of Sciences, Budapest, Hungary.
authors.forename: Barna
authors.initials: B
authors.lastname: Vásárhelyi
authors.affiliation: Department of Pulmonology, Semmelweis University, Budapest, Hungary.
authors.forename: Lilla
authors.initials: L
authors.lastname: Tamási
mesh_terms: D000328:Adult; D001249:Asthma / Q000097:blood* / Q000628:therapy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000097:blood* / Q000628:therapy; D012372:ROC Curve
chemical_list: D006820:Hyaluronic Acid
references.citation: Thorax. 2006 Feb;61(2):169-76
references.pmid: 16443708
references.citation: Am J Respir Crit Care Med. 1998 Oct;158(4):1091-5
references.pmid: 9769265
references.citation: Eur Respir J. 2006 May;27(5):908-12
references.pmid: 16707391
references.citation: Scand J Clin Lab Invest. 2001 Apr;61(2):131-7
references.pmid: 11347980
references.citation: Am J Respir Crit Care Med. 1995 Sep;152(3):865-71
references.pmid: 7663797
references.citation: Int Arch Allergy Appl Immunol. 1989;88(4):373-6
references.pmid: 2722257
references.citation: Respir Med. 2011 Feb;105(2):159-64
references.pmid: 21145223
references.citation: Am J Respir Crit Care Med. 2000 Jan;161(1):9-16
references.pmid: 10619791
references.citation: Am J Respir Cell Mol Biol. 2000 Oct;23(4):444-51
references.pmid: 11017908
references.citation: Thorax. 2009 Feb;64(2):101-6
references.pmid: 19008298
references.citation: Occup Environ Med. 2002 Feb;59(2):124-8
references.pmid: 11850556
references.citation: Postepy Hig Med Dosw (Online). 2008 Dec 02;62:651-9
references.pmid: 19057507
references.citation: Clin Chest Med. 2011 Mar;32(1):93-110
references.pmid: 21277452
references.citation: Cell Mol Life Sci. 2007 Jul;64(13):1591-6
references.pmid: 17502996
references.citation: Am J Respir Crit Care Med. 1998 Feb;157(2):403-9
references.pmid: 9476850
references.citation: PLoS One. 2013;8(4):e60697
references.pmid: 23565268
references.citation: Scand J Clin Lab Invest. 1985 Oct;45(6):497-504
references.pmid: 3906849
references.citation: Thorax. 2013 Jan;68(1):19-24
references.pmid: 23042704
references.citation: Physiol Rev. 2011 Jan;91(1):221-64
references.pmid: 21248167
references.citation: Placenta. 2009 Jan;30(1):88-95
references.pmid: 19059644
references.citation: Respir Res. 2006 Oct 11;7:125
references.pmid: 17034639
references.citation: Clin Exp Allergy. 2005 Sep;35(9):1197-203
references.pmid: 16164448
references.citation: J Allergy Clin Immunol. 2004 Jul;114(1):40-7
references.pmid: 15241342
references.citation: Eur J Cell Biol. 2006 Aug;85(8):699-715
references.pmid: 16822580
references.citation: Eur Respir J. 2005 Aug;26(2):319-38
references.pmid: 16055882
references.citation: Hypertens Pregnancy. 2010 Jan;29(2):153-62
references.pmid: 20367505
references.citation: J Allergy Clin Immunol. 1991 Oct;88(4):649-60
references.pmid: 1918730
references.citation: Thorax. 1996 May;51(5):496-502
references.pmid: 8711677
references.citation: Ann Epidemiol. 2003 May;13(5):317-24
references.pmid: 12821270
references.citation: Thorax. 2005 Jun;60(6):451-4
references.pmid: 15923243
references.citation: Acta Otolaryngol Suppl. 1987;442:7-24
references.pmid: 3124495
references.citation: Chest. 2012 Jul;142(1):86-93
references.pmid: 22345378
references.citation: Biochem J. 1991 Jan 15;273(Pt 2):459-67
references.pmid: 1991041
references.citation: J Allergy Clin Immunol. 1999 Feb;103(2 Pt 2):S330-6
references.pmid: 9949333
references.citation: Clin Exp Allergy. 2006 Nov;36(11):1373-81
references.pmid: 17083347
references.citation: Obstet Gynecol. 1999 Apr;93(4):480-4
references.pmid: 10214818
references.citation: Annu Rev Cell Dev Biol. 2007;23:435-61
references.pmid: 17506690
references.citation: Scand J Clin Lab Invest. 1992 Nov;52(7):613-21
references.pmid: 1455153
references.citation: J Allergy Clin Immunol. 2011 Aug;128(2):403-411.e3
references.pmid: 21570715
references.citation: J Biol Chem. 2008 Mar 7;283(10):6058-66
references.pmid: 18165226
references.citation: J Asthma. 2010 Feb;47(1):46-50
references.pmid: 20100020
references.citation: Am J Respir Crit Care Med. 1995 May;151(5):1354-8
references.pmid: 7735584