A protein used in wound healing may predict post-COVID lung sequelae

Periostin, a key protein in wound healing, may be a good prognostic biomarker for the emergence of fibrotic changes in the lungs after COVID-19, according to a multicenter study led by Valencia Hospital Incliva Health Research Institute.

The results of this prospective and observational study have just been published in the American Journal of Respiratory Cell and Molecular Biology in an article titled “Biomarkers of Fibrosis in Covid-19 Patients.” One year after hospital discharge: a prospective cohort study.”

Fibropulmonary sequelae after Covid-19 have been widely described, and there are “significant concerns” about the long-term effects of the SARS-CoV-2 pandemic. To date, multiple 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.

The prognosis is poor, with untreated 5-year survival rates ranging from 20% to 40%. In Spain, the estimated number of patients with IPF ranges from 8,000 to 12,000, with an incidence rate of 4.6-7.4 cases.

The purpose of this study was to analyze whether there are fibrogenic biomarkers in patients with covid-19 pneumonia that can predict post-illness pulmonary sequelae. The researchers found that periostin measured two months after admission “predicted” the presence of radiographic fibrous changes and impaired diffusion one year after admission.

Representing the Incliva-Hospital Clínico in the study were Alba Mulet, Julia Tarrasó and Jaime Signes-Costa from the Respiratory Disease Research Group and Pulmonology Department of the Institute’s Hospital Clínico de València, and Juan Antonio Carbonell from the Incliva-Hospital Clínico . Incliva biometric unit.

In addition, the Pulmonary Department of the General Hospital of Valencia has been involved; the Hospital Virgen de la Arrixaca and the Hospital los Arcos del Mar Menor, both in Murcia; the Virgen Rocio Hospital of Seville; according to the institute The facility also includes Madrid’s La Princesa Hospital, a statement reported.

Periostin is a key protein in wound healing and mediating tissue remodeling, so when elevated periostin levels are detected in IPF patients, it means there is an area 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 the development of pulmonary fibrosis changes after covid-19, which would allow the selection of those patients at high risk for progressive fibrosis.

The findings were praised in an editorial for the publication, which highlighted the clinical challenges of finding validated biomarkers to guide personalized medical decisions regarding post-covid-19 pulmonary fibrosis, and the relevance of the results obtained. sex.

The study was conducted among patients admitted to hospital with bilateral pneumonia due to covid-19. Patients were divided into two groups based on severity and underwent blood samples, respiratory function tests and high-resolution CT scans 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% are male. There were differences between the groups in terms of age, radiological involvement, length of stay, and laboratory parameters of inflammation. Differences between 2 months and 12 months were also found in all functional tests. At 12 months, 63% of patients had complete response on high-resolution CT scans, but 29.4% still had fibrous changes. Biomarker analysis showed a difference in periostin after two months. No differences were found after one year.

Results indicate that periostin early after hospital discharge can predict the presence of fibrotic changes in the lungs. The researchers believe it would “make sense” to conduct new studies with larger population samples and consider other types of patients, as the population studied here was a relatively sick group and all were hospitalized, so it is not yet clear whether It is clear whether Periostin would be valuable as a biomarker in patients who develop pulmonary fibrosis but do not require hospitalization.

In this study, periostin was used to predict unresolved pulmonary fibrosis 12 months after infection after being detected radiographically two months after infection. The institute noted that validating its use before the onset of fibrosis to stratify patients who will develop fibrosis would be “even more valuable” for intervention purposes.

“In all diseases that eventually progress to pulmonary fibrosis, early diagnosis is important because if left untreated, a poor prognosis ensues. Additionally, currently approved treatments are less effective as they only halt the progression of the disease. development. Dr. Jaime Signes-Costa, Coordinator of the Respiratory Diseases Research Group at Incliva and Head of Pulmonary Services at Valencia Hospital, explains:

To that end, the Incliva Respiratory Disease Research Group will begin a new Phase 2 trial this year to study the efficacy and safety of several drugs in IPF.