Vascular remodeling in asthma: from mechanisms to precision medicine

TY - JOUR

T1 - Vascular remodeling in asthma

T2 - from mechanisms to precision medicine

AU - Poto, Remo

AU - Chan, Rory

AU - Lagnese, Gianluca

AU - Portacci, Andrea

AU - Varricchi, Gilda

N1 - Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, Inc.

PY - 2026/5/15

Y1 - 2026/5/15

N2 - PURPOSE OF REVIEW: Angiogenesis and lymphangiogenesis are increasingly recognized as dynamic components of airway remodeling in asthma, with potential contributions to airway wall thickening, edema, ventilation-perfusion mismatch and fixed airflow limitation. This review updates mechanistic and translational evidence from the most recent literature and positions vascular biology within precision medicine and disease-modification frameworks.RECENT FINDINGS: Recent integrative concepts place epithelial barrier dysfunction and alarmin programs upstream of structural disease, providing a biologically plausible bridge between chronic airway injury, innate immune activation and endothelial plasticity across asthma endotypes. Advanced imaging is reshaping phenotyping by enabling non-invasive assessment of structure-function relationships, including airway wall abnormalities and vascular/perfusion signatures relevant to longitudinal monitoring. Long-term data on upstream biologic therapy support sustained clinical benefits over years, strengthening the rationale to test whether vascular abnormalities are modifiable endpoints rather than static consequences of past inflammation.SUMMARY: Vascular remodeling should be considered a clinically meaningful dimension of asthma heterogeneity that may explain persistent impairment despite inflammatory control. Integrating circulating angiogenesis-related mediators with imaging-derived vascular indices could refine risk stratification, inform treatment selection and accelerate a shift from symptom control toward durable disease modification.

AB - PURPOSE OF REVIEW: Angiogenesis and lymphangiogenesis are increasingly recognized as dynamic components of airway remodeling in asthma, with potential contributions to airway wall thickening, edema, ventilation-perfusion mismatch and fixed airflow limitation. This review updates mechanistic and translational evidence from the most recent literature and positions vascular biology within precision medicine and disease-modification frameworks.RECENT FINDINGS: Recent integrative concepts place epithelial barrier dysfunction and alarmin programs upstream of structural disease, providing a biologically plausible bridge between chronic airway injury, innate immune activation and endothelial plasticity across asthma endotypes. Advanced imaging is reshaping phenotyping by enabling non-invasive assessment of structure-function relationships, including airway wall abnormalities and vascular/perfusion signatures relevant to longitudinal monitoring. Long-term data on upstream biologic therapy support sustained clinical benefits over years, strengthening the rationale to test whether vascular abnormalities are modifiable endpoints rather than static consequences of past inflammation.SUMMARY: Vascular remodeling should be considered a clinically meaningful dimension of asthma heterogeneity that may explain persistent impairment despite inflammatory control. Integrating circulating angiogenesis-related mediators with imaging-derived vascular indices could refine risk stratification, inform treatment selection and accelerate a shift from symptom control toward durable disease modification.

KW - airway remodeling

KW - angiogenesis

KW - asthma

KW - endothelial dysfunction

KW - precision medicine

UR - https://www.scopus.com/pages/publications/105043511400

U2 - 10.1097/ACI.0000000000001164

DO - 10.1097/ACI.0000000000001164

M3 - Article

C2 - 42138551

SN - 1473-6322

VL - 26

SP - 321

EP - 330

JO - Current opinion in allergy and clinical immunology

JF - Current opinion in allergy and clinical immunology

IS - 4

ER -