Recent developments regarding periostin in bronchial asthma

Abstract

Although it is currently recognized that bronchial asthma is not a single disease but a syndrome, we have not yet made use of our new understanding of this heterogeneity as we treat asthma patients. To increase the efficacy of anti-asthma drugs and to decrease costs, it is important to stratify asthma patients into subgroups and to develop therapeutic strategies for each subgroup. Periostin has recently emerged as a biomarker for bronchial asthma, unique in that it is useful not in diagnosis but in categorizing asthma patients. We first found that periostin is a novel component of subepithelial fibrosis in bronchial asthma downstream of IL-13 signals. Thereafter, it was shown that periostin can be a surrogate biomarker of type 2 immune responses, the basis of the notion that a detection system of serum periostin is potentially a companion diagnostic for type 2 antagonists. Furthermore, we have recently shown that serum periostin can predict resistance or hyporesponsiveness to inhaled corticosteroids, based on its contribution to tissue remodeling or fibrosis in bronchial asthma. Thus, serum periostin has two characteristics as a biomarker for bronchial asthma: it is both a surrogate biomarker of type 2 immune responses and a biomarker reflecting tissue remodeling or fibrosis. We can take advantage of these characteristics to develop stratified medicine in bronchial asthma.

Using Periostin as a Biomarker in the Treatment of Asthma

“…Periostin is an extracellular matrix (ECM) protein belonging to the fasciclin family, based on its homology to fasciclin 1 (FAS1) 123. Periostin also acts as a matricellular protein that functions in cell activation by binding to its receptors, several integrins—α V β1, α V β3, α V β5, α 6 β4, and α M β 2 —on the cell surface.…”

“…The actions of periostin as both an ECM protein and as a matricellular protein are important for the development and remodeling of many tissues, such as bone, heart, and skin 12. Moreover, it has been revealed that periostin plays an important role in allergic inflammation, including asthma 234. Based on these findings, much attention has been paid to periostin as a useful biomarker for treating asthma.…”

Immune monitoring for precision medicine in allergy and asthma

“…Improved identification of patients whose disease has a “T H 2 endotype”[31,35], using biomarkers including periostin[39,40] and high levels of blood eosinophils[41], has been used to recommend therapies targeting T H 2 response components (e.g., IL-4, IL-5, IL-13 and/or their receptors)[42–47]. However, it appears that there are many pitfalls in attempts to develop these new diagnostic categories for patient populations differing by age, race, or other factors that may alter the correlation of disease phenotype with individual biomarkers.…”

Toward precision medicine and health: Opportunities and challenges in allergic diseases

“…While this is an active area of research, there already are data indicating that patients whose asthma is associated with elevated levels of biomarkers of a "T H 2 phenotype", 12,25 including periostin 26,27 and high levels of blood eosinophils, 28 will benefit more from therapy targeting elements of the T H 2 response (e.g., IL-4, IL-5, IL-13 and/or their receptors) than will patients with low levels of such biomarkers. [29][30][31][32][33][34] However, recent data indicate that such "biomarkers" may be more useful in some patient subpopulations than others.…”