Due to long-term immunosuppression, compromised immune surveillance, and persistent inflammatory stress, kidney transplant recipients are much more likely to develop cancer. Therefore, it is therapeutically significant to find trustworthy biomarkers for early cancer risk assessment in this group. One possible sentinel biomarker is serum periostin, a matricellular protein implicated in fibrosis, immunological modulation, and extracellular matrix remodeling.
In healthy adult tissues, periostin expression is quite low, but it is significantly elevated in cancer and chronic inflammation. It encourages angiogenesis, tumor-stromal interactions, and the epithelial-mesenchymal transition. Elevated levels have been linked to poor outcomes and the development of cancer in a variety of malignancies.
Through mechanisms including transforming growth factor-β signaling, persistent graft damage, fibrotic remodeling, and exposure to immunosuppressive drugs may further increase periostin expression in kidney transplant recipients. Serum periostin is a circulating, noninvasive marker that has benefits for long-term tracking. Assessing its function might enhance cancer risk assessment, facilitate tailored monitoring, and enhance long-term results for kidney transplant users.
Thus, this study assessed the relationship between de novo malignancy incidence following kidney transplantation and serum POSTN, transgelin (TAGLN), and highly sensitive interleukin 6 (hsIL-6). For this study, researchers tested 32 healthy controls and 127 KTRs had their serum levels of POSTN, TAGLN, and hsIL-6. The median (IQR) duration of patient follow-up was 29 (25-32) months.
While transgelin (4.62[0.34] vs. 4.30[0.29] ng/mL) and hsIL-6 (1.51[0.50] vs. 0.99[0.37] pg/mL) were raised (p < 0.001 for all), log-transformed serum POSTN concentrations were lower in the KTx group (mean [SD]: 6.80[0.53] pmol/l). The final model's discrimination was good (AUC 0.83; 95% CI 0.74-0.91). Higher chances of cancer were seen in patients in the moderate POSTN zone (OR 4.40; 95% CI 1.21-16.91, p = 0.011).
Time after KTx was independently correlated with higher POSTN levels (β = 0.20; p < 0.001). Smokers (β = -0.19; p = 0.026), patients with CV disease (β = -0.200; p = 0.008), and elderly patients (β = -0.005; p = 0.011) all had lower TAGLN levels. Overall, elevated serum POSTN is an independent marker of new-onset cancer in KTx patients. Additional prospective assessment is necessary.
Reference:
Sączek, A., Batko, K., Banaszkiewicz, M., Małyszko, J., Koc-Żórawska, E., Żórawski, M., Niezabitowska, K., Siek, K., Kraśniak, A., Bętkowska-Prokop, A., Krzanowska, K., & Krzanowski, M. (2025). Serum periostin: a sentinel for malignancy risk in kidney transplant recipients. Biomarkers in Medicine, 1–11. https://doi.org/10.1080/17520363.2025.2595907
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