A common feature of both heart failure and inflammation is the occurrence of extensive tissue remodeling.
1,2 Nearly all forms of heart failure involve remodeling of the extracellular matrix (ECM) and associated changes in ventricular geometry.
2,3 Similarly, chronic inflammatory diseases involve extensive changes in tissue architecture, such as goblet cell metaplasia, airway wall thickening and increased airflow resistance in asthma,
4 and tissue fibrosis in diseases such as eosinophilic esophagitis (EE).
5,6Eosinophilic esophagitis is an emerging worldwide disease, as documented by recent case series from Switzerland, Australia, Israel, Italy, Spain, Japan, England, and the United States.
7 EE clinically mimics gastroesophageal reflux disease and can lead to esophageal fibrosis, narrowing, and stricture
8 likely due to tissue remodeling that leads to impaired functional responses (e.g., motility). Murine models have established a role of T helper type 2 cytokines, especially interleukin (IL)-13, in EE development, as intratracheal instillation of IL-13 induces EE in mice.
9,10 In humans, preliminary investigations have suggested that circulating T cells and eosinophils from EE patients overproduce IL-13,
11,12 and IL-13 is markedly overproduced in esophageal tissue of EE patients; in addition, IL-13 is able to induce an EE-like transcriptome in primary esophageal epithelial cell cultures.
13 Moreover, transforming growth factor-
β (TGF
β), a cytokine involved in tissue fibrosis, and its signaling molecules SMAD-2/3 have been shown to be overexpressed in EE esophageal biopsies.
5 Based on genome-wide microarray transcript profile analysis of esophageal tissue, several IL-13-induced genes have been demonstrated to be increased in EE (such as eotaxin-3 and IL-13 receptor alpha2).
14 Among these genes, periostin has attracted our attention, as very recent studies have shown that periostin is involved in remodeling and repair responses in the heart. Furthermore, it is induced in T helper type 2-associated responses in the lung, although a role in this response has not been shown.
3,15,16Periostin is a 90-kDa secreted protein involved in cell adhesion, but otherwise of relatively unknown function. Periostin contains four repetitive fasciclin domains that are similar to insect fasciclin I, which is involved in neuronal cell–cell adhesion.
17 Periostin has a dynamic expression profile in both the developing heart and in adult tissue where it is induced during active remodeling or active stress.
16,18,19 Periostin is almost exclusively expressed by fibroblasts or cells that adopt fibroblast-like characteristics following injury. As a secreted protein associated with areas of fibrosis, periostin directly interacts with other ECM proteins, such as fibronectin, tenascin-C, collagen, and heparin.
15 Periostin is a ligand for select integrins including
αV
β3,
αV
β5, and
α6
β4,
20 where it can affect the ability of cells (fibroblasts or malignant cells) to migrate and/or undergo a mesenchymal transformation in select tissues. Interestingly, these same integrins (
αV
β3 and
αV
β5) are implicated in receptor-mediated apoptotic eosinophil engulfment by human airway epithelial cells.
21Of note, a recent study has shown that mechanical stretch, a phenomenon that may occur in the thickened esophagus of EE patients,
22–24 increases periostin expression in cardiac myocytes and fibroblasts.
25 Recently generated periostin-null mice have revealed a role for periostin in cardiac myocyte and fibroblast function, particularly in the tissue remodeling response.
3 Furthermore, extracellular periostin has been shown to induce proliferation of cardiomyocytes following cardiac injury.
16 Taken together, these findings prompted us to test the role of periostin in EE, as this disease is characterized by marked tissue remodeling (e.g., fibrosis), hyperplasia of the cells in contact with the ECM (epithelial cells), and tissue dysfunction (dysmotility).
5,6 Our results define a novel role for periostin in promoting eosinophil accumulation
in vitro and
in vivo.