{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T06:03:26Z","timestamp":1784527406976,"version":"3.55.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Growth differentiation factor 11 (GDF11), a member of the transforming growth factor beta (TGF-\n                      <jats:italic>\u03b2<\/jats:italic>\n                      ) superfamily, is implicated in tissue remodeling and inflammation. However, its role in asthma, particularly during exacerbations remains unclear. This study investigated the association between serum GDF11 levels and asthma severity, inflammatory responses, and airway remodeling in pediatric patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study enrolled 107 children with asthma (72 with stable asthma and 35 with acute exacerbations) and 110 age- and sex-matched healthy controls. Pulmonary function parameters, inflammatory biomarkers, airway remodeling-related factors, and serum GDF11 levels were assessed. Correlation analyses and multivariate logistic regression were performed to evaluate the association between serum GDF11 levels and clinical characteristics. Receiver operating characteristic (ROC) analysis was used to assess the diagnostic performance of GDF11 in identifying asthma exacerbations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Compared with healthy controls, children with asthma exhibited significantly lower serum GDF11 levels (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), which were further reduced during exacerbations (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Multivariate analysis identified higher GDF11 levels as being independently associated with reduced odds of exacerbation (odds ratio [OR]\u202f=\u202f0.879, 95% confidence interval [CI]: 0.776\u20130.995,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.041). Serum GDF11 levels were positively correlated with pulmonary function parameters (FEV1:\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.387, FEV1\/FVC:\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.681, PEF:\n                      <jats:italic>r<\/jats:italic>\n                      \u202f=\u202f0.357; all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and inversely correlated with eosinophil counts, total immunoglobulin E (IgE), fractional exhaled nitric oxide (FeNO), inflammatory cytokines (IL-1\u03b2, IL-4, IL-6, TNF-\n                      <jats:italic>\u03b1<\/jats:italic>\n                      ), and airway remodeling markers (TGF-\u03b21, SDF-1\u03b1, MMP-2, MMP-9) (all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05). ROC analysis indicated that serum GDF11 distinguished asthma exacerbation with good accuracy (AUC\u202f=\u202f0.839, sensitivity\u202f=\u202f77.6%, and specificity\u202f=\u202f77.3%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Reduced serum GDF11 levels are associated with asthma exacerbations, airway inflammation, and remodeling in pediatric patients. GDF11 may serve as a potential biomarker of asthma severity and exacerbation risk and is associated with airway inflammatory and structural changes in children with asthma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1872411","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:33:54Z","timestamp":1784525634000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of serum growth differentiation factor 11 with asthma severity, inflammation, and airway remodeling in pediatric patients"],"prefix":"10.3389","volume":"13","author":[{"given":"Yanran","family":"Che","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Shanghai Pudong New Area People's Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Shanghai Pudong New Area People's Hospital","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"872","DOI":"10.1111\/j.1365-2222.2008.02971.x","article-title":"Pathogenesis of asthma","volume":"38","author":"Holgate","year":"2008","journal-title":"Clin Exp Allergy"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e85","DOI":"10.1155\/2010\/318029","article-title":"Airway remodelling in asthma: from benchside to clinical practice","volume":"17","author":"Bergeron","year":"2010","journal-title":"Can Respir J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"263","DOI":"10.3389\/fmicb.2013.00263","article-title":"Pathology of asthma","volume":"4","author":"Kudo","year":"2013","journal-title":"Front Microbiol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1796","DOI":"10.1183\/13993003.01196-2014","article-title":"Novel concepts in airway inflammation and remodelling in asthma","volume":"46","author":"Saglani","year":"2015","journal-title":"Eur Respir J"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1038\/nri3786","article-title":"Type 2 inflammation in asthma-present in most, absent in many","volume":"15","author":"Fahy","year":"2015","journal-title":"Nat Rev Immunol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1165\/rcmb.2010-0027TR","article-title":"Role of transforming growth factor-\u03b2 in airway remodeling in asthma","volume":"44","author":"Halwani","year":"2011","journal-title":"Am J Respir Cell Mol Biol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1369\/0022155415627681","article-title":"TGF-\u03b2\/SMAD pathway and its regulation in hepatic fibrosis","volume":"64","author":"Xu","year":"2016","journal-title":"J Histochem Cytochem"},{"key":"ref8","first-page":"67","article-title":"Identification and association of TGF\u03b2-1 expression in patients with asthma in a polish population - Lodz metropolitan area study","volume":"4","author":"Panek","year":"2013","journal-title":"Int J Biochem Mol Biol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"191","DOI":"10.3389\/fmed.2020.00191","article-title":"Airway remodeling in asthma","volume":"7","author":"Hough","year":"2020","journal-title":"Front Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/j.cmet.2015.05.010","article-title":"GDF11 increases with age and inhibits skeletal muscle regeneration","volume":"22","author":"Egerman","year":"2015","journal-title":"Cell Metab"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1016\/j.cell.2013.04.015","article-title":"Growth differentiation factor 11 is a 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development","volume":"293","author":"Andersson","year":"2006","journal-title":"Genes Dev"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1126\/science.1251152","article-title":"Restoring systemic GDF11 levels reverses age-related dysfunction in mouse skeletal muscle","volume":"344","author":"Sinha","year":"2014","journal-title":"Science"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1038\/nrneph.2016.48","article-title":"TGF-\u03b2: the master regulator of fibrosis","volume":"12","author":"Meng","year":"2016","journal-title":"Nat Rev Nephrol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"121650","DOI":"10.1016\/j.lfs.2023.121650","article-title":"The role of GDF11 during inflammation - an overview","volume":"322","author":"Machelak","year":"2023","journal-title":"Life Sci"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"2036","DOI":"10.1016\/j.ajpath.2024.07.016","article-title":"Growth differentiation factor 11 evokes lung injury, inflammation, and fibrosis in mice through the Activin a receptor type II-like kinase, 53kDa-Smad2\/3 signaling pathway","volume":"194","author":"Li","year":"2024","journal-title":"Am J Pathol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1080\/02770903.2017.1396474","article-title":"Chinese guidelines for childhood asthma 2016: major updates, recommendations and key regional data","volume":"55","author":"Hong","year":"2016","journal-title":"J Asthma"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1378\/chest.06-1335","article-title":"Portable exhaled nitric oxide measurement: comparison with the \"gold standard\" technique","volume":"131","author":"Menzies","year":"2007","journal-title":"Chest"},{"key":"ref21","volume-title":"Global Strategy for Asthma Management and Prevention","year":"2024"},{"key":"ref22","first-page":"283","article-title":"Novel cytokine-directed therapies for asthma","volume":"11","author":"Walsh","year":"2011","journal-title":"Discov Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1038\/s41590-025-02212-9","article-title":"The immunology of asthma","volume":"26","author":"Lambrecht","year":"2025","journal-title":"Nat Immunol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"217","DOI":"10.2174\/187152210793663810","article-title":"Metabolic functions of myostatin and gdf11","volume":"10","author":"McPherron","year":"2010","journal-title":"Immunol Endocr Metab Agents Med Chem"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"12258","DOI":"10.18632\/aging.202881","article-title":"Growth differentiation factor 11: a \"rejuvenation factor\" involved in regulation of age-related diseases?","volume":"13","author":"Ma","year":"2021","journal-title":"Aging"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"S95","DOI":"10.1016\/j.jaci.2009.10.047","article-title":"Asthma: clinical expression and molecular mechanisms","volume":"125","author":"Lemanske","year":"2010","journal-title":"J Allergy Clin Immunol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1016\/j.immuni.2019.03.018","article-title":"The cytokines of asthma","volume":"50","author":"Lambrecht","year":"2019","journal-title":"Immunity"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1097\/MCP.0b013e32834d09a5","article-title":"Inflammatory biomarkers in severe asthma","volume":"18","author":"Chung","year":"2012","journal-title":"Curr Opin Pulm Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1378\/chest.12-3073","article-title":"Mechanisms of airway remodeling","volume":"144","author":"Hirota","year":"2013","journal-title":"Chest"},{"key":"ref30","first-page":"39","article-title":"The role of SDF-1\/CXCR4 on airway inflammation and airway remodeling in a rat asthma model","volume":"38","author":"Mo","year":"2015","journal-title":"Zhonghua Jie He He Hu Xi Za Zhi"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2021\/6645072","article-title":"Role of matrix metalloproteinases in angiogenesis and its implications in asthma","volume":"2021","author":"Bajbouj","year":"2021","journal-title":"J Immunol Res"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1475","DOI":"10.1007\/s11357-020-00279-w","article-title":"Candidate rejuvenating factor GDF11 and tissue fibrosis: friend or foe?","volume":"42","author":"Frohlich","year":"2020","journal-title":"Geroscience"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1038\/nrm3434","article-title":"TGF\u03b2 signalling in context","volume":"13","author":"Massagu\u00e9","year":"2012","journal-title":"Nat Rev Mol Cell 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Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1872411\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T05:33:55Z","timestamp":1784525635000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1872411\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":36,"alternative-id":["10.3389\/fmed.2026.1872411"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1872411","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]},"article-number":"1872411"}}