Association of serum monomeric periostin level with outcomes of acute exacerbation of idiopathic pulmonary fibrosis and fibrosing nonspecific interstitial pneumonia

Figures

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  Figure 1. Serum monomeric periostin (M-PN) levels in patients with AE-FIP, patients with stable IPF, and healthy controls. The whiskers show ranges, and the bars indicate mean M-PN levels. Serum M-PN level was significantly higher in AE-FIP patients than in healthy controls. *P<0.05.

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  Figure 2. Change in serum M-PN level in survivors and non-survivors. The whiskers show ranges, the bars show median M-PN levels, and “x” indicates mean M-PN level. Among survivors, serum M-PN level was significantly lower on day 7 than on day 0 (9.3±2.8 vs. 14.6±5.8 ng/mL, respectively; P<0.001). In contrast, serum M-PN level did not significantly change in non-survivors (14.6±5.1 vs. 13.2±5.1 ng/mL, respectively; P=0.07). *P<0.05.

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  Figure 3. ROC curves to determine the optimal cutoff value of ΔM-PN (expressed as change in M-PN from day 0 to day 7) for predicting survival, which was −2.7 ng/mL (sensitivity, 85.7%; specificity, 75.0%; area under the curve, 0.732).

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  Figure 4. Kaplan-Meier survival curves for 3-month survival in patients with a ΔM-PN of <−2.7 ng/mL (n=13) and >−2.7 ng/mL (n=11). Survival at 3 months was significantly better for a ΔM-PN of <−2.7 ng/mL (n=13) than for a ΔM-PN of ≥−2.7 ng/mL (n=11) (92.3% vs. 36.3%, respectively; P=0.002). *P<0.05.

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  Figure 5. Representative findings of SLB and autopsied specimens obtained from a 66-year-old man with IPF. (A) Stable IPF. SLB specimens of stable IPF showed strong expression of periostin in fibroblastic foci, with patchy distributions. (B) AE-IPF. Autopsied specimens obtained from patients with AE-IPF also showed strong expression in fibrotic lesions. The numbers of periostin-positive cells and α-SMA-positive cells in fibrotic lesions were higher in AE-IPF than in stable IPF. HE: hematoxylin and eosin staining; Periostin: rat anti-human periostin monoclonal antibodies (mAbs) of immunoglobulin G1κ (IgG1κ; clone no. SS19B or SS5D, produced in the laboratory of Biomolecular Sciences, Saga Medical School, Saga, Japan); α-SMA: mouse anti-human alpha-smooth muscle actin (α-SMA)-Abs (clone 1A4, Dako, Japan); IgGκ: purified mouse IgG1κ-Abs (BioLegend, USA).