Role of P-selectin and the receptor for advanced glycation end products (RAGE) in the development of obesity-associated bronchial asthma in adults

BACKGROUND: Obesity-associated bronchial asthma is a common and difficult-to-treat phenotype of adult asthma. Currently, asthma is classified into two major endotypes: Th2 and non-Th2. The non-Th2 endotype reflects a non-allergic inflammatory mechanism but lacks clearly defined laboratory criteria, unlike the Th2 endotype. In this context, P-selectin and the receptor for advanced glycation end products (RAGE) are of particular interest as potential markers of non-allergic inflammation. However, their role remains insufficiently studied.

AIM: This study aimed to evaluate the role of P-selectin and the receptor for advanced glycation end products (RAGE) in the development of bronchial asthma in adults with obesity.

METHODS: A cross-sectional consecutive study was conducted. Clinical characteristics, spirometric parameters, and immunological markers were assessed in patients with and without obesity, depending on the presence of bronchial asthma. Immunological markers were evaluated using enzyme-linked immunosorbent assay, including P-selectin, receptor for advanced glycation end products (RAGE), interleukin-4, interleukin-8, tumor necrosis factor alpha, and interferon gamma.

RESULTS: 96 participants were divided into four groups: group I, patients with bronchial asthma without obesity (n = 29); group II, patients with bronchial asthma and obesity (n = 27); group III (control), normal-weight individuals (n = 22); group IV (control), individuals with obesity (n = 8). Comparative analysis between the two asthma groups revealed no substantial differences in the analyzed markers; however, both groups differed remarkably from the control group III. Median P-selectin levels in groups I and II were 57.49 (46.82–129.29) pg/mL and 114.4 (58.5–161.5) pg/mL, respectively, which were significantly higher than in the control group III: 44.99 (34.00–60.07) pg/mL (p < 0.05). Elevated levels of RAGE and TNF-α were also observed, indicating the presence of a systemic inflammatory response associated with obesity in patients with bronchial asthma.

CONCLUSION: The study demonstrated substantial similarity of immunological responses in bronchial asthma and obesity. In the presence of both conditions, P-selectin demonstrated the most specific response, confirming the neutrophilic nature of inflammation.