Periostin Identified as Key Biomarker for Differentiating Sinonasal Lesions

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Extracellular matrix proteins show efficacy for distinguishing between sinonasal lesions, including antrochoanal polyps, nasal polyps, and inverted papilloma.

“Emerging evidence suggests that extracellular matrix proteins, particularly periostin, fibronectin, and tenascin-C, play pivotal roles in tissue remodeling, fibrosis, and inflammation, all of which are central to the pathogenesis of sinonasal lesions,” researchers wrote in Colombia Medica. “Despite their potential significance, comparative analyses of these markers across different sinonasal lesions are limited.”

To address this gap, the study team conducted a retrospective investigation using tissue samples from patients with antrochoanal polyps, nasal polyps and inverted papilloma. They used immunohistochemical staining with periostin, fibronectin, and tenascin-C dyes, and the samples were evaluated by a pathologist.

Researchers analyzed the expression of periostin, tenascin C, and fibronectin in stromal tissue on a 5-point scale ranging from no detectable staining to expression seen throughout the stroma. They also examined the intensity of epithelial staining using a 4-point scale, ranging from negative (0) to strong (3).

The primary outcome was the differential expression patterns of periostin, fibronectin, and tenascin-C in antrochoanal polyps, nasal polyps, and inverted papillomas. Secondary outcomes included the demographic distribution of patients (age and gender) and the impact of these factors on polyp types.

Expression Across Different Sinonasal Lesions

 The researchers assessed results from 70 patients. The cohort had a 5:2 ratio of men to women and a mean age of approximately 40 years. All patients with nasal polyps had bilateral polyps; this group also had the highest rate of smoking (67%).

The analysis demonstrated significantly higher stromal periostin staining in patients with nasal polyps compared with those with antrochoanal polyps and inverted papillomas. Fibronectin expression was also markedly increased in nasal polyps, especially in the stroma, a finding that supports its role in inflammatory tissue remodeling, according to the researchers.

Antrochoanal polyps had significantly increased epithelial periostin expression relative to inverted papillomas. Tenascin-C expression did not differ significantly among the lesion types.

Factors Associated With Different Lesions

“In the comparison between inverted papilloma and antrochoanal polyp, age was a significant predictor,” the researchers wrote. “Each additional year of age increased the odds of having an inverted papilloma by 34% (OR=1.34; P=0.00064). Higher epithelial periostin levels were associated with significantly reduced odds of inverted papilloma (OR= 0.012; P=0.0026), while higher stromal periostin levels significantly increased the odds (OR=15.64; P=0.0127).”

For patients with nasal polyps versus antrochoanal polyps, male sex was a significant predictor, raising the odds by approximately 59-fold (OR= 59.47; P=0.024). Age was also a significant factor, with every extra year increasing the odds by 26% (OR=1.26; P=0.0022), according to the study results. Increased epithelial periostin levels significantly decreased the odds (OR=0.034; P=0.014), while higher stromal periostin levels significantly increased the odds (OR=41.28; P=0.0018). Fibronectin levels in both compartments had significant positive associations (P<0.05).

Diagnostic Precision & Novel Therapeutic Targets

 The findings indicate that periostin is “the most promising marker” for distinguishing between sinonasal lesions, particularly because of the distinct epithelial and stromal staining patterns observed, according to study investigators.

“Notably, the significantly lower periostin levels in inverted papillomas raise important questions regarding its role in tumor biology and malignant transformation,” the researchers wrote. “Understanding these molecular differences could enhance diagnostic precision and potentially uncover novel therapeutic targets. Future research should focus on elucidating periostin-related signaling pathways and its interactions with other extracellular matrix proteins to contribute to the development of targeted strategies for sinonasal diseases.”