Serum Periostin Biomarker in Asthma With Comorbid Upper Airway Disease

Measurement of serum periostin biomarkers shows high diagnostic accuracy in detecting the presence and severity of chronic rhinosinusitis with polyps in patients with asthma, according to a study published recently in the Annals of the American Thoracic Society.¹

Takamitsu Asano, MD, from the Department of Respiratory Medicine, Allergy, and Clinical Immunology at Nagoya City University in Japan, and colleagues investigated the usefulness of serum periostin as a diagnostic biomarker for upper airway disease in patients with asthma.

Chronic rhinosinusitis and allergic rhinitis frequently coexist in patients with asthma,² with the prevalence of these conditions steadily increasing worldwide.³ “These upper airway inflammatory diseases are considered risk factors for the exacerbation and poor control of asthma,” wrote Dr Asano and colleagues.

Many biomarkers, including blood and sputum eosinophils, fractional exhaled nitric oxide, serum immunoglobulin E, and serum eotaxin, have been used to evaluate the helper T-cell inflammatory response, a primary characteristic of both upper airway disease and asthma.¹ In patients with severe asthma, only blood and sputum eosinophil counts and fractional exhaled nitric oxide biomarkers have been associated with severe chronic rhinosinusitis.¹

In addition, periostin may have utility in phenotyping asthma, as periostin levels have been found to be associated with treatment response in anti-interleukin 13 therapy, airway eosinophilia, aspirin-exacerbated respiratory disease, and a rapid deterioration in lung function in patients with asthma receiving inhaled corticosteroid therapy.¹

Investigators from previous studies have identified elevated serum periostin levels in patients with asthma and chronic rhinosinusitis,^4,5 particularly in chronic rhinosinusitis with nasal polyps. Because serum periostin may be a sensitive biomarker for comorbid upper airway disease in patients with asthma, Dr Asano and colleagues investigated the diagnostic accuracy of periostin in comparison with eosinophil counts (blood and sputum), fractional exhaled nitric oxide, serum immunoglobulin E, and serum eotaxin. In addition, sinus computed tomography was used to assess the severity of chronic rhinosinusitis, and these results were compared with serum periostin levels.

The prospective study was performed between July 2014 and December 2015 and included 65 patients with stable asthma (20 without upper airway disease, 22 with rhinitis, and 23 with chronic rhinosinusitis) from a single clinic in Japan.

Results showed elevated serum periostin levels in those patients with asthma with chronic rhinosinusitis vs those without upper airway disease (109.6 vs 83.2 ng/mL; P =.04). Patients with asthma with both chronic rhinosinusitis and nasal polyps had higher serum periostin levels than those without nasal polyps (130.0 vs 87.9 ng/mL; P =.001).

In receiver operator characteristic curve analysis, serum periostin showed moderate diagnostic accuracy for detecting chronic rhinosinusitis (area under the curve, 0.71; P =.01), but high diagnostic accuracy for detecting chronic rhinosinusitis with nasal polyps (area under the curve, 0.86; P =.0002).

Serum periostin was the only biomarker that detected the presence of nasal polyps when comparing patients with asthma and chronic rhinosinusitis with nasal polyps with those patients with asthma who did not have these comorbidities.

In addition, serum periostin uniquely predicted chronic rhinosinusitis severity, determined by sinus computed tomography, in patients with asthma.

“[Periostin] appears superior to blood and sputum eosinophil counts because it reflects chronic rhinosinusitis severity, suggesting that it can be used to evaluate the impact of chronic rhinosinusitis on asthma,” the researchers concluded. “Blood and sputum eosinophils are associated with the presence of comorbid upper airway diseases in patients with asthma. Our study suggests that a combined analysis of these biomarkers may be helpful in understanding the pathophysiology of allergic upper airway disease.”

Study Limitations

• Researchers did not distinguish between perennial rhinitis and seasonal rhinitis.
• Nasal and sinus tissue was not histologically evaluated; it is unclear whether blood, sputum, and exhaled biomarkers “simply reflect” eosinophilic inflammation of the upper airways.
• The majority of patients included in this study had mild to moderate asthma.

Disclosures: Dr Asano reports receiving grants from Novartis Pharma, AstraZeneca, MSD, and Eisai Co.

References

1. Asano T, Kanemitsu Y, Takemura M, et al. Serum periostin as a biomarker for comorbid chronic rhinosinusitis in patients with asthma. Ann Am Thorac Soc. 2017;14(5):667-675. doi : 10.1513/AnnalsATS.201609-720OC
2. Jarvis D, Newson R, Lotvall J, et al. Asthma in adults and its association with chronic rhinosinusitis: the GA2LEN survey in Europe. Allergy. 2012;(1)67:91-98. doi: 10.1111/j.1398-9995.2011.02709.x
3. Pawanker R, Canonica GW, Holgate ST, Canonica W, Lockey RF, Blaiss MS. World Allergy Organization (WAO) white book on allergy: update 2013. Milwaukee, WI: World Allergy Organization. http://www.worldallergy.org/wao-white-book-on-allergy. Published 2013. Accessed June 28, 2017.
4. Kanemitsu Y, Matsumoto H, Izuhara K, et al. Increased periostin associates with greater airflow limitation in patients receiving inhaled corticosteroids. J Allergy Clin Immunol. 2013;132(2):305-312.e3. doi: 10.1016/j.jaci.2013.04.050
5. Matsusaka M, Kabata H, Fukunaga K, et al. Phenotype of asthma related with high serum periostin levels. Allergol Int. 2015;64(2):175-180. doi: 10.1016/j.alit.2014.07.003