Research led by Harvard University and the Karolinska Institute in Sweden shows a ratio of blood biomarkers is able to predict who will have a serious asthma flareup in the next five years with a high level of accuracy.
The team measured sphingolipids and steroid hormones in the blood and found that the ratio between the two sets of biomarkers was predictive of asthma flareups, as outlined in a paper describing the work published in Nature Communications.
“One of the biggest challenges in treating asthma is that we currently have no effective way to tell which patient is going to have a severe attack in the near future,” said co-lead author Jessica Lasky-Su, ScD, associate professor at the Channing Division of Network Medicine at Mass General Brigham and Harvard Medical School, in a press statement.
“Our findings solve a critical unmet need. By measuring the balance between specific sphingolipids and steroids in the blood, we can identify high-risk patients with 90% accuracy, allowing clinicians to intervene before an attack occurs.”
The researchers analyzed clinical and metabolic data from more than 2,500 people who took part in three Mass General Brigham asthma cohorts, all consisting of subsets of participants selected from the Mass General Brigham Biobank.
After first testing to see which metabolic pathways looked different in people with asthma, the researchers used targeted mass spectrometry to measure different molecules in the blood of the participants. These included fats called sphingolipids, natural steroid hormones made by the body like androgens and estrogens, and small molecules made or modified by gut bacteria.
Although these biomarkers were not predictive on their own, the team found that the ratio of sphingolipids to steroid hormones in the blood was strongly linked to the risk of asthma flare ups.
The team tested a range of different sphingolipid to steroid hormone ratios, some including more and some less of the two different types of biomarkers. Lasky-Su and colleagues were able to develop a five-year model that was able to predict who would have an asthma flare-up with approximately 90% accuracy when added to basic clinical factors like medication use. They were also able to confirm this in an independent study group, in which they achieved 89% accuracy over five years.
For comparison purposes, the investigators also showed that a model using standard clinical information collected by clinicians such as prior flare history, lung function or blood eosinophils was less accurate and only predicted flare-ups with 50-70% accuracy.
“We found that the interaction between sphingolipids and steroids drives the risk profile. This ratio approach is not only biologically meaningful but also analytically robust, making it highly suitable for development into a practical cost-effective clinical test,” said co-lead author Craig Wheelock, PhD, a principal researcher at the Institute of Environmental Medicine at the Karolinska Institute.
