# The amount of hyaluronic acid and airway remodelling increase with the severity of inflammation in neutrophilic equine asthma

## TL;DR

This study shows that hyaluronic acid levels and airway changes increase with the severity of inflammation in a type of horse asthma.

## Contribution

The study is the first to investigate hyaluronic acid and airway remodelling in naturally occurring neutrophilic equine asthma.

## Key findings

- Hyaluronic acid concentration in bronchoalveolar lavage fluid was higher in EA horses compared to controls.
- Severe neutrophilic airway inflammation showed more airway remodelling than moderate cases and controls.
- Hyaluronic acid staining intensity did not significantly differ between groups in endobronchial biopsies.

## Abstract

Equine asthma (EA) is a chronic lower airway inflammation that leads to structural and functional changes. Hyaluronic acid (HA) has crucial functions in the extracellular matrix homeostasis and inflammatory mediator activity. HA concentration in the lungs increases in several human airway diseases. However, its associations with naturally occurring EA and airway remodelling have not been previously studied. Our aim was to investigate the association of equine neutrophilic airway inflammation (NAI) severity, airway remodelling, and HA concentration in horses with naturally occurring EA. We hypothesised that HA concentration and airway remodelling would increase with the severity of NAI. HA concentrations of bronchoalveolar lavage fluid supernatant (SUP) and plasma of 27 neutrophilic EA horses, and 28 control horses were measured. Additionally, remodelling and HA staining intensity were assessed from endobronchial biopsies from 10 moderate NAI horses, 5 severe NAI horses, and 15 control horses.

The HA concentration in SUP was higher in EA horses compared to controls (p = 0.007). Plasma HA concentrations were not different between the groups. In the endobronchial biopsies, moderate NAI horses showed epithelial hyperplasia and inflammatory cell infiltrate, while severe NAI horses also showed fibrosis and desquamation of the epithelium. The degree of remodelling was higher in severe NAI compared to moderate NAI (p = 0.048) and controls (p = 0.016). Intense HA staining was observed in bronchial cell membranes, basement membranes, and connective tissue without significant differences between the groups.

The release of HA to the airway lumen increases in naturally occurring neutrophilic EA without clear changes in its tissue distribution, and significant airway remodelling only develops in severe NAI.

The online version contains supplementary material available at 10.1186/s12917-024-04136-2.