Biomarkers for predicting pulmonary fibrosis

The results of this multicenter, prospective and observational study have just been published in American Journal of Respiratory Cell and Molecular Biologyin an article titled Fibrosis biomarkers in COVID-19 patients.One year after hospital discharge: a prospective cohort study. Fibropulmonary sequelae following 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 the 5-year survival rate without treatment ranging from 20% to 40%. In Spain, the estimated number of IPF patients ranges from 8,000 to 12,000, with an incidence rate of 4.6-7.4 cases per 100,000 inhabitants, 13 cases per 100,000 women and 20 cases per 100,000 women. man.

Biomarkers for COVID-19 patients

The aim of this study was to analyze whether there are biomarkers of fibrosis in patients with covid-19 pneumonia that can predict subsequent pulmonary sequelae.

The researchers found that periostin measured 2 months after admission predicted the presence of radiographic fibrous changes and impaired diffusion at 12 months after admission.

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 discovery was praised in an editorial in the publication titled A pandemic within a pandemic; predicting pulmonary fibrosis after COVID-19which highlights the clinical challenge of finding “validated biomarkers to guide personalized medical decisions regarding post-COVID-19 pulmonary fibrosis” and the relevance of the results obtained.

research Development

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.

All functional tests also found differences between 2 and 12 months. At 12 months, 63% of patients had complete regression on high-resolution computed tomography, but 29.4% of patients still had fibrous changes. Biomarker analysis showed differences in periostin at 2 months. No differences were found at 12 months. Results indicate that periostin early after hospital discharge can predict the presence of fibrotic changes in the lungs.

follow up

“In all diseases that ultimately progress to pulmonary fibrosis, early diagnosis is important because if left untreated they are associated with a poor prognosis. Additionally, currently approved treatments are less effective as they only slow down fibrosis progression without being able to completely stop it, therefore, it is necessary to study new treatment options,” explains Dr. Jaime Signes. INCLIVA Research Group on Respiratory Diseases and Director of the Pulmonology Department at Valencia Clinic Hospital.

He added: “This is why the INCLIVA Respiratory Disease Research Group will begin a new Phase II trial this year to investigate the efficacy and safety of several drugs in the treatment of IPF.”

Representing INCLIVA-Hospital Clínico in the study were Alba Mulet, Julia Tarrasó and Jaime Signes-Costa from the INCLIVA Respiratory Diseases Research Group and the Pulmonology Department of the Hospital Clinic of Valencia, and Juan Antonio from the Pulmonology Department of INCLIVA-Hospital Clínico Carbonell INCLIVA Biometric Unit. Also participating are the Pulmonology Department of the General Hospital of Valencia; the Hospital Virgen de la Arrixaca and the Hospital los Arcos del Mar Menor, both in Murcia; the Virgen Rocio Hospital of Seville; and the Princess of Madrid Hospital.

Item reference:

Mulet, A., Tarrasó, J., Rodríguez-Borja, E., Carbonell-Asins, JA, Lope-Martínez, A., Martí-Martinez, A., Murria, R., Safont, B., Fernandez-Fabrellas , E., Ros, JA, Rodriguez-Portal, JA, Andreu, AL, Soriano, JB, & Signes-Costa, J. (2023). Biomarkers of fibrosis in COVID-19 patients one year after hospital discharge: a prospective cohort study. American Journal of Respiratory Cell and Molecular Biology, 69(3), 321–327. https://doi.org/10.1165/rcmb.2022-0474OC