Association of serum growth differentiation factor 11 with asthma severity, inflammation, and airway remodeling in pediatric patients.

BACKGROUND

Growth differentiation factor 11 (GDF11), a member of the transforming growth factor beta (TGF-β) superfamily, is implicated in tissue remodeling and inflammation. However, its role in asthma, particularly during exacerbations remains unclear. This study investigated the association between serum GDF11 levels and asthma severity, inflammatory responses, and airway remodeling in pediatric patients.

METHODS

This cross-sectional study enrolled 107 children with asthma (72 with stable asthma and 35 with acute exacerbations) and 110 age- and sex-matched healthy controls. Pulmonary function parameters, inflammatory biomarkers, airway remodeling-related factors, and serum GDF11 levels were assessed. Correlation analyses and multivariate logistic regression were performed to evaluate the association between serum GDF11 levels and clinical characteristics. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic performance of GDF11 in identifying asthma exacerbations.

RESULTS

Compared with healthy controls, children with asthma exhibited significantly lower serum GDF11 levels (p < 0.001), which were further reduced during exacerbations (p < 0.001). Multivariate analysis identified higher GDF11 levels as being independently associated with reduced odds of exacerbation (odds ratio [OR] = 0.879, 95% confidence interval [CI]: 0.776-0.995, p = 0.041). Serum GDF11 levels were positively correlated with pulmonary function parameters (FEV1: r = 0.387, FEV1/FVC: r = 0.681, PEF: r = 0.357; all p < 0.001) and inversely correlated with eosinophil counts, total immunoglobulin E (IgE), fractional exhaled nitric oxide (FeNO), inflammatory cytokines (IL-1β, IL-4, IL-6, TNF-α), and airway remodeling markers (TGF-β1, SDF-1α, MMP-2, MMP-9) (all p < 0.05). ROC analysis indicated that serum GDF11 distinguished asthma exacerbation with good accuracy (AUC = 0.839, sensitivity = 77.6%, and specificity = 77.3%).

CONCLUSION

Reduced serum GDF11 levels are associated with asthma exacerbations, airway inflammation, and remodeling in pediatric patients. GDF11 may serve as a potential biomarker of asthma severity and exacerbation risk and is associated with airway inflammatory and structural changes in children with asthma.