Day-time variation of serum periostin in asthmatic adults treated with ICS/LABA and adults without asthma

Identification of diurnal rhythmic blood markers in bronchial asthma

Rationale

Asthma is a rhythmic inflammatory disease of the airway, regulated by the circadian clock. "Spill-over" of airway inflammation into the systemic circulation occurs in asthma and is reflected in circulating immune cell repertoire. The objective of the present study was to determine how asthma impacts peripheral blood diurnal rhythmicity.

Methods

10 healthy and 10 mild/moderate asthma participants were recruited to an overnight study. Blood was drawn every 6 h for 24 h.

Main results

The molecular clock in blood cells in asthma is altered; PER3 is significantly more rhythmic in asthma compared to healthy controls. Blood immune cell numbers oscillate throughout the day, in health and asthma. Peripheral blood mononucleocytes from asthma patients show significantly enhanced responses to immune stimulation and steroid suppression at 16:00 h, compared to at 04:00 h. Serum ceramides show complex changes in asthma: some losing and others gaining rhythmicity.

Conclusions

This is the first report showing that asthma is associated with a gain in peripheral blood molecular clock rhythmicity. Whether the blood clock is responding to rhythmic signals received from the lung or driving rhythmic pathology within the lung itself is not clear. Dynamic changes occur in serum ceramides in asthma, probably reflecting systemic inflammatory action. The enhanced responses of asthma blood immune cells to glucocorticoid at 16:00 h may explain why steroid administration is more effective at this time.

Periostin as a biomarker in chronic rhinosinusitis: A contemporary systematic review

BACKGROUND

The role of periostin, a matricellular protein encoded by the POSTN gene, in chronic rhinosinusitis with nasal polyposis (CRSwNP) is reviewed. Periostin is considered a potential biomarker of endotype and may be useful for evaluating response to treatment.

METHODS

Search terms in PubMed and Web of Science (1990-March 2022) included: ((periostin) OR (POSTN)) AND ((sinusitis) OR (nasal polyp) OR (CRSwNP) OR (CRS). The primary outcomes were differences in tissue, serum, and nasal lavage between CRSwNP and CRS without NP (CRSsNP) or controls. Associated factors reported to affect periostin expression, data regarding participants' clinical characteristics, disease endotypes, laboratory methods, and samples' origin were also pooled. Studies on <10 patients were excluded.

RESULTS

Out of 101 records harvested through database searching, 29 prospective cross-sectional or case-control studies were eligible for review and qualitative analysis. Tissue sample origin, concurrent infection, current and past medication, primary or recurrent disease, allergic rhinitis, and smoking status should be considered as confounding factors for periostin levels. Periostin and POSTN messenger RNA (mRNA) levels were consistently and significantly higher in CRSwNP than CRSsNP and controls. Despite the distinctly different inflammation patterns among CRSwNP endotypes, periostin-related remodeling patterns seemed to be similar.

CONCLUSION

Tissue and serum periostin levels, and POSTN expression appear elevated in CRSwNP, especially in eosinophilic inflammation, compared to CRSsNP and controls. Disease severity and comorbidities are also reflected in periostin and POSTN values. Carefully designed prospective studies may establish the role of periostin as a biomarker in CRSwNP and allow its incorporation in clinical practice.

Pathological Roles and Clinical Usefulness of Periostin in Type 2 Inflammation and Pulmonary Fibrosis

Periostin is known to be a useful biomarker for various diseases. In this article, we focus on allergic diseases and pulmonary fibrosis, for which we and others are now developing detection systems for periostin as a biomarker. Biomarker-based precision medicine in the management of type 2 inflammation and fibrotic diseases since heterogeneity is of utmost importance. Periostin expression is induced by type 2 cytokines (interleukin-4/-13) or transforming growth factor-β, and plays a vital role in the pathogenesis of allergic inflammation or interstitial lung disease, respectively, andits serum levels are correlated disease severity, prognosis and responsiveness to the treatment. We first summarise the importance of type 2 biomarker and then describe the pathological role of periostin in the development and progression of type 2 allergic inflammation and pulmonary fibrosis. In addition, then, we summarise the recent development of assay methods for periostin detection, and analyse the diseases in which periostin concentration is elevated in serum and local biological fluids and its usefulness as a biomarker. Furthermore, we describe recent findings of periostin as a biomarker in the use of biologics or anti-fibrotic therapy. Finally, we describe the factors that influence the change in periostin concentration under the healthy conditions.

Role of serum periostin in the management of asthma and its comorbidities

Type-2 airway inflammation is a major characteristic of asthma. Assessing its degree of severity is, therefore, essential in asthma management. Periostin, a matricellular protein belonging to the fasciclin family, is a key molecule linking type-2 airway inflammation and airway remodeling. Fortunately, periostin can be detected in the blood and used to provide sustaining airway information on type-2 inflammation and remodeling. Serum periostin is elevated in the eosinophilic/type 2 subtype of severe asthma, and its levels remain relatively stable and reflect genetic backgrounds. This suggests that serum periostin may serve as a marker of geno-endophenotype with type-2 airway inflammation and thus could be a predictive marker of the long-term prognosis of asthma under treatment. As expected, serum periostin is particularly elevated in comorbidities associated with the eosinophilic/type 2 subtype of severe asthma, including eosinophilic chronic rhinosinusitis, aspirin-exacerbated respiratory diseases, allergic bronchopulmonary aspergillosis, and eosinophilic granulomatosis with polyangiitis. Conversely, serum periostin levels are relatively lower in the overweight/obese. Serum periostin measurements may help to significantly improve the management of patients with severe asthma.

Periostin: An emerging biomarker for allergic diseases

Periostin is a matricellular protein as well as an extracellular matrix (ECM) protein belonging to the fasciclin family. Periostin plays important roles as a matricellular protein in the setting of allergic diseases by binding to several integrins on various cells. Since periostin is induced mainly by IL-4 and IL-13, signature type 2 cytokines, and it is highly expressed in the subepithelial regions of many chronic allergic diseases, periostin has emerged as a novel biomarker reflecting type 2 inflammation in allergic diseases. It has, moreover, been revealed that periostin has characteristics different from other type 2 biomarkers such as eosinophil count and fractional exhaled nitric oxide (FeNO), reflecting fibrosis or tissue remodeling. From this, we may say that serum periostin is a "chronic" type 2 biomarker, whereas FeNO and possibly the eosinophil count are "acute" type 2 biomarkers. In contrast, it is still uncertain how we can apply periostin measurement to the use of biologics for allergic diseases. By examining the roles of periostin in allergy and the utility and potential of periostin in developing diagnostics against allergic diseases, it is hoped that in the near future, we can develop a new strategy to treat allergic patients.

Roles of Periostin in Asthma

Periostin is a matricellular protein that is deeply involved in type-2/eosinophilic airway inflammation and remodeling in asthma. While its expression in airway epithelial cells is correlated with the thickness of airway basement membrane, more importantly, periostin can be detected stably in blood with little variability, reflecting airway type-2 inflammation and remodeling. As for a result, serum periostin can serve as a valuable marker to identify patients with type-2 severe asthma who are insensitive to inhaled corticosteroids, and consequently have the excess decline of pulmonary function with asthma exacerbations. Serum periostin may significantly help to improve management of patients with severe asthma.

Sleep and asthma

PURPOSE OF REVIEW

There is a longstanding recognition of the detrimental effect of poorly controlled asthma on sleep, but recent years have seen a growing interest in how asthma and sleep may interact. This review examines the current evidence of relationships between asthma, sleep and sleep disorders.

RECENT FINDINGS

Poor quality sleep and sleep disturbance is highly prevalent in asthmatic patients, and particularly in those with severe asthma. Impaired sleep quality correlates with worse asthma control and quality of life. Sleep disturbance in asthma may be related to due circadian variation in airway inflammation, but may also be related to specific sleep disorders. Obstructive sleep apnoea (OSA) appears to be significantly more common in asthmatic patients than nonasthmatic patients, and treatment of OSA with continuous positive airway pressure (CPAP) may lead to improved asthma-specific quality of life. Nocturnal CPAP may also be of benefit to asthmatic patients without OSA, potentially because of stretching of airway smooth muscle. Insomnia is also highly prevalent in severe asthma patients, and is associated with a history of poor asthma control and increased healthcare utilization.

SUMMARY

Asthma, sleep and sleep disorders appear to have complex, but significant relationships. Prospective observational and controlled interventional studies are needed to quantify how addressing sleep difficulties may benefit asthma patients.

Looking for Airways Periostin in Severe Asthma: Could It Be Useful for Clustering Type 2 Endotype?

BACKGROUND

Severe asthma is heterogeneous clinically and biologically and is often difficult to control. In particular, the type 2 (T2) immunity endotype of severe asthma is gaining increasing interest because it is susceptible to newly developed biologic treatments that can transform the quality of life of these patients. The aim of this study was to analyze periostin concentrations in the airways of patients with severe asthma, evaluating its role in clustering the T2 endotype.

METHODS

We enrolled 40 consecutive patients with severe asthma (T2 endotype: n = 25; non-T2 endotype: n = 15), 21 patients with mild to moderate asthma, and 15 healthy control subjects. All subjects enrolled underwent exhaled breath condensate (EBC) and sputum collection, eosinophil count in blood, fractional exhaled nitric oxide, and IgE measurement. Periostin was assessed by an enzyme-linked immunosorbent assay kit on EBC and induced sputum (IS) supernatant.

RESULTS

We were able to detect higher periostin levels in the EBC (0.75 ± 0.46 vs 0.70 ± 0.19 vs 0.11 ± 0.05 ng/mL, P < .05 and P < .01) and in IS (0.55 ± 0.23 vs 0.31 ± 0.13 vs 0.16 ± 0.120 ng/mL, P < .05 and P < .01) of patients with severe asthma compared with patients with mild to moderate asthma and healthy control subjects, respectively. We further found an increase of periostin levels in both samples in T2 endotype compared with non-T2 endotype (EBC: 0.88 ± 0.46 vs 0.52 ± 0.46 ng/mL; IS: 0.69 ± 0.19 vs 0.39 ± 0.16 ng/mL; P < .05) and a correlation between periostin levels in EBC and sputum.

CONCLUSIONS

We found that periostin is measurable in the airways and increased in patients with severe asthma, especially in those from the T2 endotype. Unlike serum periostin, which may be derived from several sources outside the lung, airways periostin is a useful marker of severe eosinophilic asthma and may help to phenotype patients that will respond to the biologic agents.

Periostin and Dipeptidyl Peptidase-4: Potential Biomarkers of Interleukin 13 Pathway Activation in Asthma and Allergy

Periostin and dipeptidyl peptidase-4 (DPP-4) are proteins induced by type 2 cytokines interleukin (IL)-4 and IL-13 and show increased expression in asthma and diseases with type 2 inflammation, including atopic dermatitis and chronic rhinosinusitis. Both proteins can also be induced by other stimuli, such as profibrotic factors, which may confound their specificity as biomarkers of IL-13 pathway activation and type 2-driven disease. DPP-4 is important in glucose metabolism; therefore, serum concentrations may be confounded by the presence of concomitant metabolic disease. This review evaluates the potential of these biomarkers for anti-IL-13-directed therapy in asthma and diseases with type 2 inflammation.