Serum periostin in obstructive airways disease

Abstract

Serum periostin is a potential biomarker of response to therapies that target type 2 inflammation in asthma. The objectives of this study were to describe: 1) the distribution of serum periostin levels in adults with symptomatic airflow obstruction; 2) its relationship with other variables, including type 2 biomarkers; and 3) the effect of inhaled corticosteroids on periostin levels.Serum periostin levels were measured in a cross-sectional study exploring phenotypes and biomarkers in 386 patients aged 18–75 years who reported wheeze and breathlessness in the past 12 months. In 49 ICS-naïve patients, periostin levels were measured again after 12 weeks of budesonide (800 μg·day−1).The distribution of serum periostin levels was right skewed (mean±sd 57.3±18.6 ng·mL−1, median (interquartile range) 54.0 (45.1–65.6) ng·mL−1, range 15.0–164.7 ng·mL−1). Periostin was positively associated with exhaled nitric oxide (Spearman's rho=0.22, p<0.001), blood eosinophil count (Spearman's rho=0.21, p<0.001), and total IgE (Spearman's rho=0.14, p=0.007). The Hodges–Lehmann estimator (95% CI) of change in periostin level after ICS therapy was −4.8 (−6.7– −3.2) ng·mL−1 (p<0.001).These findings provide data on the distribution of serum periostin in adults with symptomatic airflow obstruction, the weak associations between periostin and other type 2 markers, and the reduction in periostin with inhaled corticosteroid therapy.

Reference ranges for serum periostin in a population without asthma or chronic obstructive pulmonary disease

“…These values are also similar to the median level of 50.2 ng/mL previously reported in adults with moderate and severe asthma inadequately controlled despite ICS therapy , and the median levels ranging from 46.4 to 49.5 ng/mL at baseline in adults with uncontrolled asthma despite high‐dose ICS therapy and a second controller, randomized to the four treatment groups . Likewise, the mean serum periostin level of 51.2 ng/mL was similar to the mean value of 53 ng/mL reported in severe persistent allergic asthma uncontrolled despite treatment with high‐dose ICS plus long‐acting beta‐agonist therapy and 57.7 ng/mL reported in our random adult population with asthma These findings suggest that periostin is not a measure which can usefully diagnose patients with asthma or discriminate patients with asthma receiving different treatment regimens across a range of severity, or from a population without asthma or COPD. It also suggests that asthma is not the major determinant of serum periostin levels and that pathophysiological processes related to its function as a matricellular protein, with expression typically confined to cells of mesenchymal origin, are likely to play a greater role .…”

“…We observed that the distribution of serum periostin levels in this population without asthma or COPD was relatively wide, with a fivefold range of levels (28.1–136.4 ng/mL), and a marked right skew distribution. The median serum periostin level of 50.1 ng/mL was similar to the median level of 53.7 ng/mL we reported in a random adult population with a doctor's diagnosis of asthma, using the same laboratory and assay to measure periostin levels . These values are also similar to the median level of 50.2 ng/mL previously reported in adults with moderate and severe asthma inadequately controlled despite ICS therapy , and the median levels ranging from 46.4 to 49.5 ng/mL at baseline in adults with uncontrolled asthma despite high‐dose ICS therapy and a second controller, randomized to the four treatment groups .…”

Biomarkers for the Phenotyping and Monitoring of Asthma in Children

“…Nevertheless, the majority of published reports in adults do demonstrate modest, yet significant relationships between circulating periostin with other proposed markers of type 2 inflammation, including exhaled NO, sputum, and blood eosinophils or total IgE [53–55]. …”

Accurately measuring and modeling Th2 and Th17 endotypes in severe asthma

“…Nitric oxide is produced by the action of iNOS encoded by the NOS2 gene, and eosinophils are mobilized by chemokines such as eotaxin-3 encoded by the CCL26 gene, both of which are inducible by IL-13 and highly correlated with the Th2 signature (18). The half life of blood eosinophils in humans is several days (19) and it is likely that serum periostin levels may fluctuate on a similar time scale (20), while serial bronchoscopy studies with anti-IL5 suggest that bronchial tissue, but not sputum eosinophils, may persist for weeks to months (21). Thus, FeNO and sputum eosinophils may reflect acute activity of type 2 cytokines in the airways whereas tissue eosinophils and blood biomarkers may reflect aggregate type 2 airway inflammation over longer time intervals.…”