According to a study directed by the INCLIVA Health Institute of the Valencia Hospital, Periostin, a key protein in wound healing, may be a good prognostic biomarker for fibrotic lung changes after COVID-19. The results of this multicenter, prospective, and observational study have just been published in the American Journal of Respiratory Cell and Molecular Biology, titled “Biomarkers of fibrosis in COVID-19 patients.” One year after hospital discharge: a prospective cohort study”.
Alba Mulet, Julia Tarrasó and Jaime Signes-Costa from the INCLIVA Respiratory Diseases Research Group and the Respiratory Department of the Hospital Clinic of Valencia, and Juan Antonio Carbonell representing the INCLIVA-Hospital Clínico participated in the study. unit. The Pulmonary Unit of the General Hospital of Valencia also intervened; the Hospital Virgen de la Arrixaca and the Hospital los Arcos del Mar Menor, both in Murcia; the Santa Maria del Rossio Hospital in Seville; and the Princesse Hospital of Madrid.
fibrotic pulmonary sequelae
Fibrotic pulmonary sequelae after COVID-19 have been widely described, and there are serious concerns about the long-term impact of the SARS-CoV-2 pandemic. To date, several biomarkers have been associated with the pathogenesis of fibrosis in interstitial lung diseases, particularly idiopathic pulmonary fibrosis (IPF), a rare chronic fibrotic interstitial disease that causes Irreversible loss of lung function. Its prognosis is poor, with untreated 5-year survival rates ranging from 20% to 40%. In Spain, the number of IPF patients is estimated to be between 8,000 and 12,000, with an incidence of 4.6-7.4 cases per 100,000 inhabitants, with a prevalence of 13 cases per 100,000 inhabitants for women and 20 cases per 100,000 inhabitants for men .
In Spain, the number of IPF patients is estimated to be between 8,000 and 12,000
The aim of this study was to analyze whether there are fibrogenesis biomarkers in patients with COVID-19 pneumonia that can predict pulmonary sequelae after COVID-19.. The researchers found that periostin measured 2 months after admission predicted the presence of radiographic fiber changes and impaired diffusion at 12 months. Periostin is a key protein in wound healing, mediating tissue remodeling, so when elevated levels of periostin are detected in IPF patients, it is indicative of areas of active fibrosis in the lungs.
This study provides new knowledge for personalized follow-up of these patients, suggesting that periostin may be a good prognostic biomarker for fibrotic changes in the lung after COVID-19, which would allow selection of those patients at high risk for progressive fibrosis.
new biomarkers
The findings were praised in an editorial in the publication, titled “Pandemic within a pandemic; predicting pulmonary fibrosis after COVID-19,” emphasizing the search for “validated biomarkers to guide predictions about COVID-19.” 19 Clinical challenges of “Personalized medical decision-making in post-pulmonary fibrosis” and the relevance of the obtained results.
The study was conducted on patients admitted with bilateral COVID-19 pneumonia. Patients were divided into two groups according to severity, and blood samples, respiratory function tests, and high-resolution CT scans were performed 2 and 12 months after discharge. A total of 135 patients were evaluated at 12 months, with a mean age of 61 years. 58.5% were men. There were differences between the groups with respect to age, radiographic involvement, length of hospital stay, and laboratory parameters of inflammation.
The aim was to analyze whether there are fibrogenesis biomarkers that can predict pulmonary sequelae in patients with COVID-19 pneumonia.
All functional tests also found differences between 2 months and 12 months. At 12 months, 63% of patients achieved full resolution on high-resolution CT scans, but fiber changes persisted in 29.4%. Biomarker analysis showed a difference in periostin at 2 months. No difference was found at 12 months. Results showed that periostin early after discharge could predict the presence of fibrotic changes in the lungs.
patient stratification
The researchers think it would be interesting to conduct the new study on a larger population sample and to consider other types of patients. The population studied here was relatively ill, all of whom had been hospitalized. Therefore, it is unclear whether periostin is valuable as a biomarker in patients with pulmonary fibrosis who do not require hospitalization.Finally, in this study Periostin for predicting unresolved pulmonary fibrosis up to 12 months after infection and radiographically detected at 2 months. Validation of its use to stratify patients expected to develop fibrosis before onset of fibrosis would be more valuable for intervention purposes.
Periostin was used to predict unresolved pulmonary fibrosis up to 12 months post-infection following radiographic examination at 2 months of infection.
“In all diseases that eventually develop into pulmonary fibrosis, early diagnosis is important because they have a poor prognosis if left untreated. In addition, currently approved treatments are less effective because they only slow fibrosis progression, It cannot be prevented completely, so it is necessary to investigate new treatment options”, he explained. Jaime Signes-Costa, Coordinator of the INCLIVA Respiratory Disease Research Group and Director of the Respiratory Department at the Valencia Clinic Hospital. “That’s why the INCLIVA Respiratory Diseases Research Group will start a new phase II trial this year to investigate the efficacy and safety of several drugs for the treatment of IPF,” added Signes-Costa.