ArticleTranslational pediatrics2026
Association of bronchoalveolar lavage fluid caspase-4 with inflammatory responses in pediatric acute respiratory distress syndrome.
Article in Translational pediatrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Acute respiratory distress syndrome (ARDS) remains a major cause of morbidity in critically ill children. Although dysregulated inflammation is central to ARDS pathogenesis, the contribution of upstream inflammatory signaling pathways, particularly caspase-4-mediated responses, has not been fully characterized in pediatric populations. This study aimed to investigate bronchoalveolar lavage fluid (BALF) levels of caspase-4 and related inflammatory mediators in children with ARDS and to examine their associations with inflammatory responses and disease severity. Methods: This retrospective study included children aged 1 month to 14 years with ARDS. After applying predefined inclusion and exclusion criteria, 28 patients with ARDS were enrolled and classified as Gram-negative bacterial infection-associated ARDS (n=14) or virus-associated ARDS (n=14), along with a separate non-infectious control group (n=17). BALF samples were collected during clinically indicated bronchoscopy. Levels of caspase-4, interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were measured using enzyme-linked immunosorbent assay (ELISA). Correlation analyses were performed to assess associations between caspase-4 levels, cytokines, and clinical severity indicators. Results: BALF levels of caspase-4, IL-1β, IL-6, and TNF-α did not differ significantly among the three groups. However, caspase-4 levels were positively correlated with IL-1β (r=0.641, P<0.001), IL-6 (r=0.668, P<0.001), and TNF-α (r=0.375, P=0.038). Caspase-4 was also positively associated with D-dimer levels (r=0.433, P=0.031) and showed a modest association with oxygenation index-related measures. Conventional inflammatory markers did not demonstrate consistent associations with disease severity. Conclusions: BALF caspase-4 levels are closely associated with local inflammatory activity in pediatric ARDS (PARDS). Although no significant differences were observed among etiological groups, the correlations between caspase-4 and inflammatory cytokines suggest that caspase-4 may reflect the intensity of pulmonary inflammation rather than pathogen-specific mechanisms. These findings support its potential value as a biomarker for disease assessment in PARDS.
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