Periostin has emerged as a promising biomarker in allergic diseases, especially in the context of type 2 inflammation and airway remodeling. It has a range of biological functions, is regulated by key cytokines, and is associated with disease severity, which is why it’s been getting so much attention in recent research.
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At the same time, its clinical validity and usefulness aren’t straightforward. Factors like age, comorbidities, and differences between assays can all affect how reliable it is.
This review brings together the current evidence on periostin’s strengths and limitations as a biomarker, based on recent literature.
Summary
Recent studies have highlighted periostin’s role in allergic diseases and type 2 inflammation. Izuhara et al. provide a comprehensive overview, emphasizing periostin’s induction by IL-4 and IL-13 (see figure below) and its association with disease severity and airway remodeling.1 Their earlier work further supports periostin’s involvement in tissue remodeling and fibrosis, suggesting its potential as a marker for disease activity and progression.2 Both reviews, however, note that periostin’s clinical application is complicated by variability due to age, comorbidities, and differences in assay methodologies.
The diagnostic potential of periostin is also explored in the context of NSAID hypersensitivity. Kim et al. found that serum periostin levels could help distinguish between hypersensitivity phenotypes, though they caution that larger, longitudinal studies are needed to confirm these findings.3
Ono et al. elaborate on periostin’s pathological roles in type 2 inflammation and pulmonary fibrosis, reinforcing its relevance as a biomarker for disease severity and therapeutic response, particularly in asthma and interstitial lung diseases.4 The review also highlights the importance of considering confounding factors such as age and comorbidities.
Age-related variability is a significant consideration, especially in pediatric populations. Fujitani et al. report that serum periostin levels decrease with age in both allergic and non-allergic children, suggesting that age-adjusted reference values are necessary for valid use in children.5
In asthma management, Izuhara et al. discuss periostin’s application in guiding personalized therapy, especially for biologic treatments targeting type 2 inflammation.6 The evidence supports periostin’s role in predicting response to anti-IL-13 and anti-IL-4R therapies, though the authors recommend using periostin alongside other biomarkers for optimal clinical decision-making.
The predictive value of periostin is further supported by Sasano et al., who demonstrate that higher baseline periostin levels, in combination with other immune markers, predict better response to mepolizumab in asthmatics.7 This study highlights the benefit of a multi-biomarker approach in real-world asthma management.
Finally, Kim et al. evaluate periostin and YKL-40 as biomarkers for airway remodeling and hyperresponsiveness in pediatric asthma, finding that periostin correlates with markers of airway remodeling and disease severity.8 However, the authors stress the need for age-specific reference ranges and further validation in larger cohorts.
Comparative table: Periostin as a Biomarker. Source: IBL International GmbH, Part of Tecan Group
| Study (Year) |
Disease
Context |
Main Findings on Periostin |
Strengths as a Biomarker |
Limitations/
Considerations |
| 1. Izuhara et al. (2019) |
Allergic
diseases |
Correlates with severity, remodeling |
Good for type 2 inflammation |
Age, comorbidities, assay variability |
| 2. Izuhara et al. (2017) |
Inflammation, allergy |
Marker for activity, progression |
Monitors disease progression |
Needs further standardization |
3. Kim et al.
(2016) |
NSAID hypersensitivity |
Differentiates phenotypes |
Diagnostic
potential |
Small sample, needs validation |
| 4. Ono et al. (2021) |
Type 2 inflammation, fibrosis |
Reflects severity, therapy response |
Useful in asthma, fibrosis |
Confounding factors |
| 5. Fujitani et al. (2019) |
Pediatric allergy |
Decreases with age |
Pediatric reference values |
Age confounding |
| 6. Izuhara et al. (2016) |
Asthma |
Predicts biologic therapy response |
Personalized therapy guidance |
Use with other biomarkers |
| 7. Sasano et al. (2024) |
Asthma (mepolizumab) |
Predicts treatment response |
Multi-biomarker approach |
Combine with other markers |
8. Kim et al.
(2024) |
Pediatric asthma |
Correlates with remodeling, severity |
Remodeling
marker |
Needs age-specific ranges |
Conclusion
Collectively, the literature supports periostin as a valid and clinically useful biomarker for type 2 inflammation, allergic diseases, and airway remodeling, particularly in asthma. Its strengths include its correlation with disease severity, its association with response to biologic therapies, and its potential to help differentiate phenotypes.
That said, its validity is influenced by factors like age, comorbidities, and variability between assays. Because of this, most authors recommend using periostin alongside other biomarkers and adjusting for potential confounders to get the most reliable clinical value.
Further large-scale, standardized studies are still needed to refine how it’s used across different patient populations.
References
- Izuhara, K., et al. (2019). Periostin: An emerging biomarker for allergic diseases. Allergy, 74(11), pp.2116–2128. DOI: 10.1111/all.13814. https://onlinelibrary.wiley.com/doi/full/10.1111/all.13814.
- Kenji Izuhara, et al. (2017). Periostin in inflammation and allergy. Cellular and Molecular Life Sciences, 74(23), pp.4293–4303. DOI: 10.1007/s00018-017-2648-0. https://link.springer.com/article/10.1007/s00018-017-2648-0..
- Kim, M.-A., et al. (2016). Clinical implication of the serum periostin level for differentiating phenotypes of NSAID hypersensitivity. Allergology International, (online) 65(4), pp.492–494. DOI: 10.1016/j.alit.2016.04.013. https://www.jstage.jst.go.jp/article/allergolint/65/4/65_492/_article/-char/ja/.
- Ono, J., et al. (2021). Pathological Roles and Clinical Usefulness of Periostin in Type 2 Inflammation and Pulmonary Fibrosis. Biomolecules, (online) 11(8), p.1084. DOI: 10.3390/biom11081084. https://www.mdpi.com/2218-273X/11/8/1084.
- Fujitani, H., et al. (2019). Age-related changes in serum periostin level in allergic and non-allergic children. Allergology International, 68(2), pp.285–286. DOI: 10.1016/j.alit.2018.12.006. https://www.jstage.jst.go.jp/article/allergolint/68/2/68_285/_article/-char/ja/.
- Izuhara, K., Ohta, S. and Ono, J. (2016). Using Periostin as a Biomarker in the Treatment of Asthma. Allergy, Asthma & Immunology Research, (online) 8(6), p.491. DOI: 10.4168/aair.2016.8.6.491. https://synapse.koreamed.org/articles/1052617.
- Sasano, H., et al. (2023). Pretreatment circulating MAIT cells, neutrophils, and periostin predicted the real-world response after 1-year mepolizumab treatment in asthmatics. Allergology International, 73(1), pp.94–106. DOI: 10.1016/j.alit.2023.06.001. https://www.jstage.jst.go.jp/article/allergolint/73/1/73_94/_article/-char/ja/.
- Kim, S.J., et al. (2024). Evaluating serum periostin and YKL-40 as biomarkers for airway remodeling and hyperresponsiveness in pediatric asthma. World Allergy Organization Journal, (online) 17(11), p.100991. DOI: 10.1016/j.waojou.2024.100991. https://www.sciencedirect.com/science/article/pii/S1939455124001236.
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