Serum periostin levels in asthma patients in relation to omalizumab therapy and presence of chronic rhinosinusitis with nasal polyps

Abstract

Introduction: The serum periostin level is a promising biomarker of type 2-high inflammation pattern of bronchial asthma. It has been proven that serum periostin levels decrease in response to systemic and inhaled corticosteroid (ICS) therapy. However, we have only limited knowledge about changes in serum periostin levels reflecting omalizumab (OMA) treatment and other variables, such as chronic rhinosinusitis with nasal polyps (CRSwNP). Aim: To critically appraise clinically relevant parameters influencing periostin levels in asthma patients. Material and methods: A pilot, cross-sectional, observational study to assess serum periostin levels of 48 asthma patients (38 treated by conventional therapy comprising ICS and 10 treated by ICS and OMA as an add-on therapy) with respect to asthma clinical traits, comorbidities and to other biomarkers of type 2-high asthma phenotype (total IgE, absolute and relative eosinophil count, eosinophilic cationic protein (ECP) and a fraction of exhaled NO (FeNO)). Results: Serum periostin correlates with total IgE levels (Spearman rho = 0.364, p = 0.025) in a subgroup of conventionally treated patients, and with eosinophil count (Spearman rho = 0.401, p = 0.021) in a subgroup of patients with concurrent CRSwNP. Serum periostin levels were decreased in omalizumab-treated patients in comparison to conventionally treated patients (p = 0.025). This effect was remarkably apparent only if CRSwNP was not present (p = 0.005). Conversely, we measured elevated periostin levels in OMA-treated patients with concurrent CRSwNP (p = 0.017). Conclusions: Serum periostin production is significantly associated with treatment modality (omalizumab vs. conventional) and presence of CRSwNP. These variables need to be taken into account to interpret periostin levels accurately.

Pathological Roles and Clinical Usefulness of Periostin in Type 2 Inflammation and Pulmonary Fibrosis

“…Omalizumab significantly reduced serum periostin levels at 4 and 8 weeks after the start of the treatment [170].…”

“…When inhaled corticosteroids (ICS) are administered to asthma patients, periostin production is reduced, suggesting that airway inflammation is suppressed, and serum periostin levels have been demonstrated to decrease in response to systemic therapy and ICS therapy [170]. Conversely, if serum periostin remains elevated despite high dose inhaled corticosteroid therapy, there is a risk of airflow limitation due to steroid resistance.…”

“…In a clinical study, serum periostin has been evaluated to identify patients who are more effective with biologics and is at risk of developing asthma exacerbation and decreased lung function (Table 3). Interestingly, the use of some biologics and high doses of ICS has also been reported to decrease periostin levels [122,[170][171][172][173]. Patients with severe asthma who were not specifically using Xolair had higher plasma periostin concentrations than healthy controls [156], and using Xolair was shown to reduce periostin levels in patients with severe asthma [170,173].…”

“…Interestingly, the use of some biologics and high doses of ICS has also been reported to decrease periostin levels [122,[170][171][172][173]. Patients with severe asthma who were not specifically using Xolair had higher plasma periostin concentrations than healthy controls [156], and using Xolair was shown to reduce periostin levels in patients with severe asthma [170,173]. Thus, the use of Xolair treatment may affect the serum/plasma levels of periostin, suggesting periostin may be a possible monitoring marker.…”

Exhaled Breath Condensate—A Non-Invasive Approach for Diagnostic Methods in Asthma

“…There are reports of its higher level in the serum of children with severe asthma comparing to the control group [ 106 , 107 ] and in asthmatic patients with dynamic hyperinflation, which decreased inspiratory capacity during tachypnoea [ 108 ]. During omalizumab therapy, periostin concentration decreased more than in treatment with conventional corticosteroids [ 109 ]. The serum level of this molecule can be falsely elevated in children because it is released by osteoblasts during growth.…”