Periostin defines a pathological fibroblast program enriched in restrictive allograft syndrome

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Chronic lung allograft dysfunction (CLAD) (n=11). Intervention: Restrictive allograft syndrome (RAS) vs. Bronchiolitis obliterans syndrome (BOS). Primary outcome: POSTN expression and pathological fibroblast state proportion.

Yudai Miyashita; Taisuke Kaiho; Yuriko Yagi; Taichi Nagano; Xin Wu; Yuanqing Yan; Haiying Sun; Carl Atkinson; G. R. Scott Budinger; Ankit Bharat; Chitaru Kurihara

doi:10.1172/jci.insight.203805

August 10, 2026JCI InsightOpen Access

Periostin defines a pathological fibroblast program enriched in restrictive allograft syndrome

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Key result

Restrictive allograft syndrome is linked to expanded pathological fibroblasts and increased periostin versus bronchiolitis obliterans.

n=11

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Key Points

This research aims to identify the role of periostin-positive fibroblasts in contributing to fibrotic restrictive chronic lung allograft dysfunction after transplantation.
Analysis of fibroblast populations in lung transplant samples
Identification of POSTN-positive fibroblasts as pathogenic
Assessment of their role in fibrotic responses
POSTN-positive fibroblasts were found to be significantly enriched in cases of restrictive chronic lung allograft dysfunction
Their presence correlates with increased fibrosis levels
Evidence suggests these cells contribute directly to lung allograft damage.

Structured PICO

P

Population

11 patients with end-stage chronic lung allograft dysfunction (8 with BOS, 3 with RAS) who underwent redo lung transplantation, contributing 31 lobar samples.

O

Outcome

Fibroblast transcriptional states and POSTN (periostin) expression/immunoreactivity differences between RAS and BOSsurrogate

Limitations

The cohort was modest and restricted to explanted lungs at redo transplantation, capturing end-stage disease.
Cannot determine whether periostin elevation precedes clinical RAS, tracks disease trajectory, or reflects established fibrosis.
Primary analytic unit was the lobar specimen, requiring larger patient-level longitudinal studies for validation.
Did not determine whether periostin is mechanistically required for restrictive remodeling in CLAD.
Modest cohort restricted to explanted lungs at redo transplantation (end-stage disease)
Cannot determine whether periostin elevation precedes clinical RAS, tracks disease trajectory, or reflects established fibrosis
Primary analytic unit was the lobar specimen
Did not determine whether periostin is mechanistically required for restrictive remodeling in CLAD

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Implication

POSTN-positive pathological fibroblasts are enriched in restrictive allograft syndrome compared to bronchiolitis obliterans syndrome, suggesting periostin as a potential biomarker or therapeutic target for fibrotic chronic lung allograft dysfunction.

Abstract

This study identifies POSTN-positive pathological fibroblasts as key contributors to fibrotic restrictive chronic lung allograft dysfunction after lung transplantation.

Discussion

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Cite This Study

Miyashita et al. (2026) conducted a letter in Chronic lung allograft dysfunction (CLAD) (n=11). Restrictive allograft syndrome (RAS) vs. Bronchiolitis obliterans syndrome (BOS) was evaluated on POSTN expression and pathological fibroblast state proportion. Restrictive allograft syndrome is associated with an expansion of a pathological fibroblast state and increased periostin expression compared to bronchiolitis obliterans syndrome.

synapsesocial.com/papers/6a7d768a2b0e0cff3f63ff9b https://doi.org/10.1172/jci.insight.203805

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Periostin defines a pathological fibroblast program enriched in restrictive allograft syndrome

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Periostin defines a pathological fibroblast program enriched in restrictive allograft syndrome

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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