title: Serum Periostin as a Biomarker for Comorbid Chronic Rhinosinusitis in Patients with Asthma.
abstract: BACKGROUND
  Periostin is a matricellular protein that is involved in the pathophysiology of allergic rhinitis, chronic rhinosinusitis, and asthma. Associations of serum periostin with systemic and airway eosinophilic inflammation and comorbid chronic rhinosinusitis in patients with asthma have been demonstrated. Although serum periostin is positioned as a marker of helper T cell 2 immune responses, its implication regarding the presence of comorbid upper airway diseases in patients with asthma remains unclear.
  
  
  OBJECTIVE
  To investigate the utility of serum periostin as a diagnostic biomarker for upper airway disease in patients with asthma.
  
  
  METHODS
  We prospectively enrolled 65 patients with stable asthma, 20 without upper airway disease, 22 with rhinitis, and 23 with chronic rhinosinusitis (13 with nasal polyps, 10 without). Serum periostin, eotaxin, total IgE, fractional exhaled nitric oxide, and blood and sputum eosinophil levels were measured and compared between upper airway disease subtypes. We evaluated the utility of each biomarker in detecting upper airway disease, associations among the biomarkers, and severity of upper airway disease as measured by the Lund-Mackay score for sinus computed tomography.
  
  
  RESULTS
  Serum periostin levels were higher in patients with asthma who had chronic rhinosinusitis (109.6 ± 47.4 ng/ml) than in those without upper airway disease (83.2 ± 22.9 ng/ml) (P = 0.04). Serum periostin levels in patients with asthma who had chronic rhinosinusitis and nasal polyps were significantly higher (130.0 ± 46.6 ng/ml) than in those without nasal polyps (87.9 ± 37.7 ng/ml) (P  =  0.001). Serum periostin levels were not associated with the presence or the severity of rhinitis. In contrast, receiver operating characteristic curve analyses showed moderate diagnostic accuracy for detecting chronic rhinosinusitis (area under the curve, 0.71; P = 0.01) and high accuracy for chronic rhinosinusitis with nasal polyps (area under the curve, 0.86; P = 0.0002). When we compared patients with asthma who had comorbid chronic rhinosinusitis and nasal polyps with patients with asthma without these comorbidities, we found serum periostin to be the sole biomarker among those tested for detecting the presence of nasal polyps. Serum periostin was also the sole biomarker that significantly correlated with Lund-Mackay score in patients with chronic rhinosinusitis (r = 0.44; P = 0.04).
  
  
  CONCLUSIONS
  Serum periostin is useful for detecting chronic rhinosinusitis with nasal polyps and predicting radiological chronic rhinosinusitis severity in patients with asthma. Clinical trial registered with the UMIN Clinical Trials Registry (UMIN000017533).
authors.affiliation: 1 Department of Respiratory Medicine, Allergy and Clinical Immunology.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Asano
authors.affiliation: 1 Department of Respiratory Medicine, Allergy and Clinical Immunology.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kanemitsu
authors.affiliation: 1 Department of Respiratory Medicine, Allergy and Clinical Immunology.
authors.forename: Masaya
authors.initials: M
authors.lastname: Takemura
authors.affiliation: 2 Department of Otorhinolaryngology, and.
authors.forename: Makoto
authors.initials: M
authors.lastname: Yokota
authors.affiliation: 1 Department of Respiratory Medicine, Allergy and Clinical Immunology.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Fukumitsu
authors.affiliation: 1 Department of Respiratory Medicine, Allergy and Clinical Immunology.
authors.forename: Norihisa
authors.initials: N
authors.lastname: Takeda
authors.affiliation: 1 Department of Respiratory Medicine, Allergy and Clinical Immunology.
authors.forename: Hiroya
authors.initials: H
authors.lastname: Ichikawa
authors.affiliation: 1 Department of Respiratory Medicine, Allergy and Clinical Immunology.
authors.forename: Takehiro
authors.initials: T
authors.lastname: Uemura
authors.affiliation: 1 Department of Respiratory Medicine, Allergy and Clinical Immunology.
authors.forename: Osamu
authors.initials: O
authors.lastname: Takakuwa
authors.affiliation: 1 Department of Respiratory Medicine, Allergy and Clinical Immunology.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Ohkubo
authors.affiliation: 1 Department of Respiratory Medicine, Allergy and Clinical Immunology.
authors.forename: Ken
authors.initials: K
authors.lastname: Maeno
authors.affiliation: 1 Department of Respiratory Medicine, Allergy and Clinical Immunology.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ito
authors.affiliation: 1 Department of Respiratory Medicine, Allergy and Clinical Immunology.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Oguri
authors.affiliation: 3 Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Maki
authors.affiliation: 4 Shino-Test Corporation, Sagamihara, Japan; and.
authors.forename: Junya
authors.initials: J
authors.lastname: Ono
authors.affiliation: 5 Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga, Japan.
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Ohta
authors.affiliation: 2 Department of Otorhinolaryngology, and.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: 5 Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Izuhara
authors.affiliation: 2 Department of Otorhinolaryngology, and.
authors.forename: Motohiko
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: 1 Department of Respiratory Medicine, Allergy and Clinical Immunology.
authors.forename: Akio
authors.initials: A
authors.lastname: Niimi
mesh_terms: D000328:Adult; D001249:Asthma / Q000097:blood* / Q000276:immunology; D015415:Biomarkers / Q000097:blood; D015815:Cell Adhesion Molecules / Q000097:blood*; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006801:Humans; D007249:Inflammation; D007564:Japan; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000150:complications*; D011446:Prospective Studies; D012044:Regression Analysis; D012220:Rhinitis / Q000097:blood*; D012720:Severity of Illness Index; D012852:Sinusitis / Q000097:blood*
chemical_list: D015415:Biomarkers; D015815:Cell Adhesion Molecules; C512835:POSTN protein, human
keywords: asthma; chronic rhinosinusitis; fractional exhaled nitric oxide; periostin; rhinitis