Study from Celedón Lab for Pediatric Asthma Research Links Exposure to Violence With Inflammatory Asthma Subtypes in Puerto Rican Youth

A study from the Celedón Lab for Pediatric Asthma Research in the Division of Pediatric Pulmonary Medicine at UPMC Children’s Hospital of Pittsburgh published in Annals of the American Thoracic Society found that exposure to violence, including gun violence and its accompanying psychological stress, is linked to distinct inflammatory asthma endotypes in Puerto Rican youth.

The findings from the study highlight how social and environmental stresses experienced by the individual can help shape the underlying biology of asthma in a pediatric population who has been disproportionately affected by asthma.

Kristina Gaietto, MD, MPH, assistant professor of Pediatrics, was lead author of the study, which was conducted using data from the Epigenetic Variation and Childhood Asthma in Puerto Ricans (EVA-PR) research project. Juan C. Celedón, MD, DrPH, ATSF, chief of the Division of Pediatric Pulmonary Medicine and the Niels K. Jerne Professor of Pediatrics, was senior author.

“This study was designed to explore whether different types of violence exposure could influence the kind of asthma children and adolescents may develop,” says Dr. Gaietto. “We wanted to understand how these kinds of lived experiences might intersect with an individual’s immune biology in ways that matter for treatment options and long-term health outcomes.”

Connecting Trauma and Immune Pathways in Asthma

Prior research by Dr. Celedón’s lab has shown that exposure to violence is associated with increased asthma risk and worse asthma outcomes in children, adolescents, and young adults. However, it has been unclear whether these kinds of psychosocial stress can influence the specific molecular patterns of asthma inflammation in children.

In this study, Drs. Gaietto, Celedón, and colleagues categorized children and adolescents with asthma into one of three groups based on their airway epithelial gene expression: T2-high, T17-high, or T2-low/T17-low.

[T2-high asthma is associated with eosinophilic airway inflammation, T17-high is associated with neutrophilic airway inflammation, and T2-low/T17-low is paucigranulocytic (i.e., not associated with airway neutrophils or eosinophils).]

They then examined how exposure to violence, including lifetime exposure, recent traumatic events, and exposure or lived experience with gun violence, as well as distress related to that violence, was associated with each of the asthma endotypes.

Different Forms of Violence Associated With Different Asthma Profiles

The study found that exposure to violence was not uniformly associated with all of the asthma subtypes. Instead, several distinct patterns were uncovered in the analysis.

• Exposure to gun violence was associated with both T2-high and T17-high asthma.
• A lifetime exposure to violence was linked to the manifestation of the T17-high asthma subtype.
• Psychological stress related to exposure to violence was associated with a T2-high asthma profile.
• No exposure to violence or stress was associated with the T2-low/T17-low group.

Clinical Implications for an At-Risk Population

The results of the Celedón Lab’s study may help explain why Puerto Rican children, adolescents, and young adults, who have historically and continue to experience high rates of both asthma and exposure to violence in the community are at increased risk for difficult-to-treat asthma subtypes.

Identifying the connections between psychosocial exposures and inflammatory asthma endotypes may help to inform future clinical strategies to better personalize asthma management, especially in settings or communities where exposure to traumatic events and other stresses may be present or occur at higher rates compared to other populations.

“The findings of our team’s study, and our prior work on this topic continue to highlight the need to consider social determinants of health in the biological evaluation of asthma in young individuals,” Dr. Celedón says. “Understanding the immune pathways affected by exposure to things like violence and other traumatic occurrences could eventually lead us to adopt more targeted treatment approaches for our asthma patients.”

Reference

• Gaietto K, Yue M, Han YY, Rosser FJ, Canino G, Forno E Chen W, Celedón JC. Exposure to Violence and Asthma Endotypes in Puerto Rican Youth. Ann Am Thorac Soc. 2025 June 23. Online ahead of print.

Further Reading

Previously published research on this topic from the Celedón Lab for Pediatric Asthma Research includes:

• Han YY, Yan Q, Chen W, Celedón JC. Child Maltreatment, Anxiety and Depression, and Asthma Among British Adults in the UK Biobank. Eur Respir J. 2022 Oct 27; 60(4): 2103160.
• Gaietto K,Han YY, Forno E, Acosta-Perez E, Marsland A, Miller GE, Rosser FJ, Chen W, Canino G, Celedón JC. Exposure to Violence and Asthma in Puerto Rican Youth With High Th2 Immunity. Pediatr Pulmonol. 2023 Aug; 58(8): 2289-2297.
• Ramratnam SK, Han YY, Rosas-Salazar C, Forno E, Brehm JM, Rosser F, Marsland AL, Colón-Semidey A, Alvarez M, Miller GE, Acosta-Pérez E, Canino G, Celedón JC. Exposure to Cung Violence and Asthma Among Children in Puerto Rico. Respir Med. 2015 Aug; 109(8): 975-981.
• Han YY, Forno E, Celedón JC. Health Risk Behaviors, Violence Exposure, and Current Asthma Among Adolescents in the United States. Pediatr Pulmonol. 2019 Mar; 54(3): 237-244.