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Review
. 2016 Nov;8(6):491-8.
doi: 10.4168/aair.2016.8.6.491.

Using Periostin as a Biomarker in the Treatment of Asthma

Kenji Izuhara  1 , Shoichiro Ohta  2 , Junya Ono  2   3
Affiliations
Review

Using Periostin as a Biomarker in the Treatment of Asthma

Kenji Izuhara et al. Allergy Asthma Immunol Res. 2016 Nov.

Abstract

Periostin acts both as an extracellular matrix protein belonging to the fasciclin family and as a matricellular protein functioning in cell activation by binding to its receptors on the cell surface. It has been established that periostin is a downstream molecule of interleukin (IL)-13, a signature type 2 cytokine, and that periostin plays an important role in the pathogenesis of allergic diseases, including asthma. Based on these findings, much attention has been paid to periostin as a biomarker useful in the treatment of asthma. Periostin is a surrogate biomarker for type 2 immunity; it has been shown that serum periostin can predict the efficacy of anti-IL-13 antibodies (lebrikizumab) and anti-IgE antibodies (omalizumab), and that this usefulness can be potentially expanded to other type 2 antagonists. Moreover, it has been shown that periostin is not a simple surrogate biomarker for type 2 immunity; periostin-high asthma patients have several unique characteristics, including eosinophilia, high fraction of nitric oxide, aspirin intolerance, nasal disorders, and late onset. These characteristics are likely to be correlated with the involvement of periostin in the tissue remodeling of asthma. Periostin is also associated with hyporesponsiveness to inhaled corticosteroids, probably reflecting tissue remodeling. Thus, periostin has 2 characteristics as a biomarker for early diagnosis of asthma: surrogate biomarkers for type 2 immunity and tissue remodeling. Based on these characteristics, we will be able to apply serum periostin to treatment of asthma.

Keywords: Periostin; asthma; biomarker; cluster; companion diagnostic; molecularly targeted drug.

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Figures

Fig. 1
Fig. 1. Expression of periostin in asthmatic patients. The histochemical localization of periostin in asthmatic patients is depicted. The left and right panels show bronchial tissues from an asthmatic patient in H&E staining (A) and immunostaining (B) of periostin. Periostin in the right panel is stained brown and is localized in the thickened basement membrane in asthmatic patients.
Fig. 2
Fig. 2. Algorithm for the treatment of asthma. A first-line antiasthma drug is ICSs. If a patient is resistant or hyporesponsive to ICSs, serum periostin should be measured If a patient shows a high periostin level, type 2 antagonists should be added. If a patient shows a low periostin level, other agents or therapies are recommended.
Fig. 3
Fig. 3. Serum periostin levels according to age. (A) Serum periostin levels in the elementary school-age children without allergic diseases. Bottom of the box, 25th percentile; Line in the middle of box, median; Top of the box, 75th percentile; Whiskers, to the smallest value and to the largest value. (B) The serum periostin levels of subjects without allergic diseases in both elementary school-age children and adults.
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