The usefulness of monomeric periostin as a biomarker for idiopathic pulmonary fibrosis

Abstract

The natural course of idiopathic pulmonary fibrosis (IPF) is variable. Predicting disease progression and survival in IPF is important for treatment. We previously demonstrated that serum periostin has the potential to be a prognostic biomarker for IPF. Our aim was to use monomeric periostin in a multicenter study to evaluate its efficacy in diagnosing IPF and predicting its progression. To do so, we developed a new periostin kit to detect only monomeric periostin. The subjects consisted of 60 IPF patients in a multicenter cohort study. We applied monomeric periostin, total periostin detected by a conventional kit, and the conventional biomarkers—KL-6, SP-D, and LDH—to diagnose IPF and to predict its short-term progression as estimated by short-term changes of %VC and % DL, CO. Moreover, we compared the fraction ratios of monomeric periostin to total periostin in IPF with those in other periostin-high diseases: atopic dermatitis, systemic scleroderma, and asthma. Monomeric periostin showed the greatest ability to identify IPF comparable with KL-6 and SP-D. Both monomeric and total periostin were well correlated with the decline of %VC and % DL, CO. Clustering of IPF patients into high and low periostin groups proved useful for predicting the short-term progression of IPF. Moreover, the relative ratio of monomeric periostin was higher in IPF than in other periostin-high diseases. Measuring monomeric periostin is useful for diagnosing IPF and predicting its short-term progression. Moreover, the ratio of monomeric periostin to total periostin is elevated in IPF compared to other periostin-high diseases.

<p>Confounding Patient Factors Affecting the Proper Interpretation of the Periostin Level as a Biomarker in Asthma Development</p>

“…24 On the other hand, high amounts of POSTN could interact with TNFα or IL-1α in fibroblasts to stimulate NF-κB that could result in lung fibrosis. 25 It is well known that high serum POSTN can be a predictive marker for effective anti-IL-13 antibody treatment in asthmatic patients 26 and a prognostic marker for increased risk of asthma exacerbations and progressive decline in lung function. 6 However, whether increased POSTN expression has protective or deleterious effects in asthma, is still a matter of debate.…”

“…It has been previously reported that POSTN deficient mice challenged with inhaled aeroallergen showed an exaggerated serum IgE and bronchial hyperresponsiveness that might be due to the POSTN effect on TGF-β-induced T regulatory cell differentiation. 25 Moreover, POSTN deficiency was shown to enhance polyps like lesion formation and mast cell infiltration. 27 Technical challenges that hinder the use of POSTN include post-translational modifications as well as the existence of multiple differentially spliced isoforms in various proportions in diverse tissues and disease states.…”

IL-13 induces periostin and eotaxin expression in human primary alveolar epithelial cells: Comparison with paired airway epithelial cells

“…In this regard, ATII cell dysfunction is a common feature of fibrotic lungs [ 23 ]. Periostin expression is elevated in lung tissue and blood of patients with IPF [ 24 , 25 ], however it remains unclear if alveolar epithelial cells contribute. Although ATII cells produce various profibrotic cytokines such as TGF-beta [ 26 , 27 ], it is unknown whether they produce periostin at the normal and diseased conditions.…”

Acute Exacerbation of Idiopathic Pulmonary Fibrosis

“…Serum periostin is elevated both the acute phase and the chronic stable phase in IPF patients [21,22].…”