Markers of vascular perturbation correlate with airway structural change in asthma

Am J Respir Crit Care Med. 2013 Jul 15;188(2):167-78. doi: 10.1164/rccm.201301-0185OC.


Rationale: Air trapping and ventilation defects on imaging are characteristics of asthma. Airway wall thickening occurs in asthma and is associated with increased bronchial vascularity and vascular permeability. Vascular endothelial cell products have not been explored as a surrogate to mark structural airway changes in asthma.

Objectives: Determine whether reporters of vascular endothelial cell perturbation correlate with airway imaging metrics in patients with asthma of varying severity.

Methods: Plasma from Severe Asthma Research Program subjects was analyzed by ELISAs for soluble von Willebrand factor mature protein (VWF:Ag) and propeptide (VWFpp), P-selectin, and platelet factor 4. Additional subjects were analyzed over 48 hours after whole-lung antigen challenge. We calculated ventilation defect volume by hyperpolarized helium-3 magnetic resonance imaging and areas of low signal density by multidetector computed tomography (less than -856 Hounsfield units [HU] at functional residual capacity and -950 HU at total lung capacity [TLC]).

Measurements and main results: VWFpp and VWFpp/Ag ratio correlated with and predicted greater percentage defect volume on hyperpolarized helium-3 magnetic resonance imaging. P-selectin correlated with and predicted greater area of low density on chest multidetector computed tomography less than -950 HU at TLC. Platelet factor 4 did not correlate. Following whole-lung antigen challenge, variation in VWFpp, VWFpp/Ag, and P-selectin among time-points was less than that among subjects, indicating stability and repeatability of the measurements.

Conclusions: Plasma VWFpp and P-selectin may be useful as surrogates of functional and structural defects that are evident on imaging. The results raise important questions about why VWFpp and P-selectin are associated specifically with different imaging abnormalities.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Asthma / blood
  • Asthma / diagnostic imaging
  • Asthma / pathology*
  • Asthma / physiopathology*
  • Bronchi / pathology*
  • Endothelium, Vascular / diagnostic imaging
  • Endothelium, Vascular / physiopathology*
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • P-Selectin / blood
  • Platelet Factor 4 / physiology
  • Protein Precursors / blood
  • Tomography, X-Ray Computed
  • von Willebrand Factor


  • P-Selectin
  • Protein Precursors
  • von Willebrand Factor
  • von Willebrand factor propolypeptide
  • Platelet Factor 4