Periostin Protein May Predict Cardiac Involvement in SSc

Study suggests periostin may be useful biomarker for systemic sclerosis

Lindsey Shapiro, PhD avatar

by Lindsey Shapiro, PhD |

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Blood levels of the periostin protein were associated with the degree of skin and cardiac involvement, but not lung or blood vessel involvement, in people with systemic sclerosis (SSc), a study found.

Levels of the protein also were higher in patients with diffuse forms of SSc, those living with the disease for a shorter time, and in male patients.

Findings overall suggest that periostin may be a useful biomarker for predicting disease severity, particularly cardiac complications, in SSc.

“To our knowledge, this is the first study to show that periostin is elevated in SSc cardiac tissue,” the researchers wrote, noting that “future work will need to prospectively investigate periostin levels in SSc patients.”

The study, “Periostin overexpression in scleroderma cardiac tissue and its utility as a marker for disease complications,” was published in the journal Arthritis Research and Therapy.

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The fibrosis (scarring) that characterizes SSc can vary significantly from patient to patient and may involve various organs, such as the lungs and heart, in addition to the skin.

“Understanding which patient is at risk for specific organ involvement early in the disease is vital, as timely therapeutic intervention may prevent disease progression and increase survival,” the researchers wrote.

Periostin is a protein that is increased in response to tissue injury and is known to be involved in fibrosis. Coupled with the fact that it’s detected non-invasively, the protein has emerged as a potential biomarker of disease severity for SSc.

To date, two studies have investigated the potential relationship, both of which found that periostin was increased in the blood and skin of SSc patients compared with healthy people. One also found that higher levels of the protein were associated with greater skin thickness, whereas neither observed a link with lung involvement.

Despite its role in cardiac tissue, no study has described a relationship between periostin and heart complications in SSc.

Potential as organ biomarker

In this study, the research team aimed to further investigate the potential role of periostin as a biomarker for various SSc organ complications.

Blood samples were obtained from 106 SSc patients enrolled in a database at the Boston University School of Medicine in Massachusetts. Most patients were women (83%), with a mean age of 55.7. Periostin levels also were measured in 22 healthy people (controls).

As for disease types, a majority of SSc participants (72.6%) had limited cutaneous SSc (lcSSc), while 27.4% had diffuse cutaneous SSc (dcSSc).

Results showed that dcSSc patients had the highest circulating levels of periostin, which were elevated significantly compared to both lcSSc and healthy individuals. Levels among lcSSc patients also were elevated compared with healthy people.

Male patients had significantly higher periostin levels than female patients. Patients in the early stage of disease — under three years — also had higher levels of periostin compared with those living with SSc for longer.

The team next investigated whether periostin correlated with specific SSc disease features.

They found that higher periostin levels were linked to a higher modified Rodnan skin score, reflecting a greater extent of skin fibrosis. In contrast, periostin levels were not associated with interstitial lung disease — disorders characterized by lung inflammation and scarring — lung function, or vascular complications, including pulmonary hypertension.

Circulating periostin levels

Periostin levels also were associated significantly with cardiac involvement. A greater level of circulating periostin was linked to echocardiography findings reflective of an enlarged left ventricle, which is the heart’s main pumping chamber.

To learn more, the team examined cardiac tissue from four patients and four healthy people. Tissue from SSc patients showed patches of periostin that weren’t observed in healthy samples.

In SSc hearts, periostin was found in areas that already were marked by fibrosis, as well as areas without any apparent fibrosis.

According to the researchers, that could mean that “accumulation of periostin in cardiac tissue of SSc patients may be an early event.”

Overall, the findings suggest that periostin is “a promising biomarker for disease progression in SSc cardiomyopathy [heart muscle disease],” the scientists wrote. “Further studies will be required to assess its utility in identifying cardiac involvement in SSc.”