Risk prediction of post-COVID conditions using NLRP3 and GSDMD markers in patients with bronchial asthma after COVID-19

Background. One of the key factors in triggering the hyperinflammation cascade in patients with bronchial asthma and COVID-19 is the activation of NLRP3 cytosolic complexes and the GSDMD proteins by SARS-CoV-2, which are effector molecules for the lytic and inflammatory forms of pyroptosis.

Aim. To determine prognostic criteria for worsening of mild bronchial asthma following an infectious disease caused by SARS-CoV-2.

Materials and Methods. In patients with mild, partially controlled bronchial asthma (n = 86), who were divided into 2 groups: asthma without COVID-19 (n = 34) and asthma following mild COVID-19 (n = 52), peripheral blood inflammatory markers were evaluated. The patients were examined immediately after recovery and confirmation of a negative SARS-COV-2 test result, and six months post-infection. The control group included conditionally healthy volunteers (n = 15) with no history of COVID-19. Pulmonary function was monitored by measuring FVCL, OFV1, and OFV1/FVCL. NLRP3 and gasdermin D inflammasomes were measured by enzyme-linked immunosorbent assay.

Results. The study revealed that in a number of patients with mild asthma, who had post-COVID conditions 6 months after COVID 19, there were elevated levels of NLRP3 inflammasome and gasdermin D (GSDMD), as well as a decreased pulmonary function, indicating a hyperinflammatory process. A predictive model for worsening of mild asthma after COVID-19 was developed: concurrent elevation of NLRP3 > 0.04 ng/ml and GSDMD > 0.38 ng/ml levels during the convalescence period serves as a marker of a high risk of post-COVID complications.

Conclusion. The role of NLRP3 and GSDMD in exacerbating the course of asthma after COVID-19 has been established, and predictive threshold values of biomarkers in this patient population have been identified.

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