A review of periostin in orthopedics

Objective: This review explores periostin (POSTN), a matricellular protein integral to developmental physiological, and pathological processes, by examining its structure, function, and emerging roles in orthopedic and non-musculoskeletal pathologies. It investigates POSTN's potential as a biomarker and therapeutic target in orthopedic diseases, with a focus on post-traumatic osteoarthritis (PTOA), addressing the need for a comprehensive analysis of its current and future clinical significance in orthopedic and musculoskeletal health. Methods: A comprehensive literature review was performed, synthesizing current available literature surrounding POSTN, including findings from human and rodent studies. Data were compiled from multiple large publication databases to provide a broad and current perspective on its roles and applications. Results: POSTN is upregulated in osteoarthritic cartilage and synovial fluid following joint injuries, such as ACL ruptures and anterior shoulder instability events. It promotes cartilage matrix degradation by upregulating catabolic enzymes and inflammatory pathways. Therapeutic silencing of POSTN with siRNA reduces inflammatory mediator expression and mitigates cartilage degeneration in rodent models. POSTN's differential expression across injury stages suggests its potential utility as a biomarker for monitoring disease progression. Conclusions: POSTN is pivotal in musculoskeletal development, fracture healing and bone biology, offering potential as a prognostic biomarker for orthopedic conditions and a tool for monitoring disease progression. Its significant role in PTOA development suggests that targeting POSTN and its downstream inflammatory mediators offer innovative strategies for managing PTOA, warranting further research and clinical exploration.