Periostin as Biomarker May Be More Useful Than Eosinophils in ECRS

Periostin levels among those who did and did not have eosinophilic chronic rhinosinusitis (ECRS) were compared in a new study to evaluate the extracellular matrix protein’s potential as a disease biomarker, with the study findings showing periostin may be more useful than eosinophils.

Findings on this potential biomarker, the overproduction of which the study investigators highlight is implicated in nasal polyp formation, were published recently in Allergology International.

Patients included in this analysis (N = 59; 22%, women; mean [SD] age, 52.9 [12.4] years) received care at the Japanese Red Cross Wakayama Medical Center or the Tohoku Medical and Pharmaceutical University, and Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis Study (JESREC) criteria were used for diagnosis. The score comprises evaluation of unilateral or bilateral disease, presence of nasal polyps, CT findings, and peripheral blood eosinophil level, and a total of 11 or more indicates preliminary ECRS diagnosis—which is confirmed via nasal polyps biopsy. Of the patients who were split into 2 groups via JESREC score, there were 33 in the ECRS group and 26 in the non-ECRS group.

“Patients with ECRS respond poorly to many treatment modalities,” they wrote. “A final diagnosis of ECRS is made by examination of a biopsy specimen or resected tissue resected from nasal polyps under a microscope. However, many aspects of the pathology of ECRS remain unclear.”

Mean (SD) overall peripheral blood eosinophil count was 7.7% (4.9%) in the ECRS group compared with 1.8% (1.5%) in the non-ECRS group, a finding the investigators determined to be statistically significant (P < .001), along with periostin results that were 124.5 (65.5) and 87.9 (29.4) ng/mL (P < .05), respectively. Further, in the ECRS group only, there was a positive correlation between peripheral blood eosinophil count and periostin level (r_s = 0.49; P < .05).

No correlations were seen between peripheral blood eosinophil count and CT score (r_s = 0.04; P > .05) or serum periostin level (r_s = 0.13; P > .05) overall (ECRS and non-ECRS groups), in the ECRS group only (r_s = 0.23; P > .05 and r_s = 0.22; P > .05, respectively), or in the non-ECRS group (r_s = –0.44; P < .05 and r_s = –0.012; P > .05).

Another overall finding on mean serum periostin levels shows a statistically significant difference between the those with unilateral and bilateral nasal polyps, respectively: 88.0 (33.8) vs 116.0 (60.1) mg/mL. Within the ECRS group only (P = .054) and the non-ECRS group only (P > .05), there were no statistically significant differences in periostin level between the unilateral and bilateral polyps groups. For mean peripheral blood eosinophils, again no statistically significant differences were seen between those with unilateral or bilateral nasal polyps (P > .05).

A positive correlation was seen between serum periostin level and JESREC score only in the ECRS group (r_s = 0.52; P < .01).

Subanalyses that investigated potential for nasal polyps recurrence found that the overall risk (ECRS and non-ECRS groups) and the risk in the ECRS group increased with higher serum periostin levels, with 93.8% sensitivity and 100% specificity and 92% sensitivity and 100% specificity, respectively. For blood eosinophil count, sensitivity and specificity were lower—92.5% and 62.5%, respectively, overall and 69.2% and 85.0% in the ECRS group—but the authors noted that the elevated specificity levels still indicated high risk of postoperative recurrence if blood eosinophils come in higher than their cutoff value of 8.8%.

“Periostin shown to be a more useful biomarker than eosinophils in ECRS,” the authors concluded. “It was shown to likely be an important biomarker for pathological severity of ECRS and postoperative recurrence of nasal polyps.”

Still, the recommend further study of the potential biomarker, as “serum periostin level is not easily measured at this time.”

Reference

Sato T, Ikeda H, Murakami K, Murakami K, Shirane S, Ohta N. Periostin is an aggravating factor and predictive biomarker of eosinophilic chronic rhinosinusitis. Allergol Int. Published online September 13, 2022. doi:10.1016/j.alit.2022.08.006