Biologics targeting type-2 inflammation, one of the key features of asthma, have introduced a new era for the management of patients with severe asthma who are inadequately controlled with high doses of inhaled corticosteroids and other controllers. However, these biologics are costly and need long-term usage, and responses to the biologics may vary in patients with severe asthma. Therefore it is necessary to find the most beneficial biologics in each patient, using biomarkers. Currently, clinically useful biomarkers to identify type-2 endotype are blood eosinophil counts and exhaled nitric oxide. However, no single biomarker is ideal and each has its own advantages and limitations, so that we need more biomarkers, including serum periostin. In addition, combination of biomarkers is much informative for precise endotyping, which may compensate for the drawbacks of each biomarker.
Periostin, a matricellular protein belonging to the fasciclin family, is a key molecule linking type-2 airway inflammation and airway remodeling. Fortunately, periostin can be detected in the blood and thus can be used to provide sustaining airway information on type-2 inflammation and remodeling. Serum periostin is elevated in the eosinophilic/type 2 subtype of severe asthma, and its levels remain relatively stable and reflect genetic backgrounds. This suggests that serum periostin may serve as a marker of geno-endophenotype with type-2 airway inflammation and thus could be a predictive marker of the long-term prognosis of asthma under treatment. Of interest, serum periostin levels are relatively lower in the overweight/obese population, which may partly explain the discrepancy between blood eosinophil counts and serum periostin levels. In this symposium, I would like to review characteristics and roles of type-2 biomarkers, including serum periostin, for precision medicine in severe difficult asthma.
: 의약학분야 > 내과학
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