Introduction: Airway remodelling in children with severe recurrent episodes of bronchial obstruction starts very early, from preschool age – a period in which the diagnosis of asthma is not yet confirmed. Assessing these early structural changes presents a challenge in clinical practice. Due to the limitations of invasive methods, reliable noninvasive markers of these changes are sought. Galectin-3 (Gal-3), a regulator of inflammatory and fibrotic processes, and Krebs von den Lungen-6 (KL-6), a marker of alveolar epithelial damage, are considered as indicators of lung remodelling. Methods: Forty-eight children were studied: 26 children under 4 years of age with recurrent episodes of wheezing (RW) and 22 with cystic fibrosis (CF). Children with RW were divided into two subgroups: those with a low frequency (≤3 episodes/year) and those with a high frequency (6 episodes/year) of bronchoobstructive symptoms. CF patients were stratified according to genotype (ΔF508 homozygous or heterozygous), and all underwent computed tomography (HRCT). Serum Gal-3 and KL-6 levels were measured by the ELISA method. The correlation between Gal-3 and KL-6 and clinical severity in children with recurrent wheezing at preschool age, and between Gal-3 and KL-6 and radiologically confirmed structural lung changes in children with cystic fibrosis, was assessed. Results: Elevated Gal-3 levels were found in children with RW from infancy. Although the differences in median Gal-3 levels did not reach statistical significance in the two RW subgroups, children with a high frequency of wheezing were 1.76 times more likely to have elevated Gal-3 (26 ng/mL) compared to those with a low frequency of RW (p = 0.02). In CF, Gal-3 levels were significantly higher in children with confirmed structural lung disease on HRCT compared to those without pathological changes (38.35 vs. 11.63 ng/mL, p = 0.001). The highest Gal-3 values were found in ΔF508 homozygous patients with bronchiectasis. KL-6 levels remained within the normal range for the pediatric population across all groups and did not correlate with the frequency of bronchoobstructive manifestations, genotype, or CT findings. Conclusion: Galectin-3 is a reliable biomarker for pediatric pulmonology practice, reflecting early pulmonary changes in children with frequent recurrent bronchoobstructive episodes and a risk of persistent manifestations, and it correlates with structural damage in cystic fibrosis patients. KL-6 has no diagnostic value in the early stages of pulmonary pathology.
Kostova et al. (Fri,) studied this question.