Biomarker signatures for progressive idiopathic pulmonary fibrosis
Open accessAbstract
Background: Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease in which circulatory biomarkers have the potential for guiding management in clinical practice. We assessed the prognostic role of serum biomarkers in three independent IPF cohorts: Australian Idiopathic Pulmonary Fibrosis Registry (AIPFR), Trent Lung Fibrosis (TLF) and Prospective Observation of Fibrosis in the Lung Clinical Endpoints (PROFILE). Methods: In the AIPFR cohort, candidate proteins were assessed by ELISA as well as in an unbiased proteomic approach. LASSO (least absolute shrinkage and selection operator) regression was used to restrict the selection of markers that best accounted for the progressor phenotype at 1 year in the AIPFR cohort, and subsequently prospectively selected for replication in the validation TLF cohort and assessed retrospectively in the PROFILE cohort. Four significantly replicating biomarkers were aggregated into a progression index model based on tertiles of circulating concentrations. Results: 189 participants were included in the AIPFR cohort, 205 participants from the TLF cohort and 122 participants from the PROFILE cohort. Differential biomarker expression was observed by ELISA and replicated for osteopontin, matrix metallopeptidase-7, intercellular adhesion molecule-1 and periostin for those with a progressor phenotype at 1 year. Proteomic data did not replicate. The progression index in the AIPFR, TLF and PROFILE cohorts predicted risk of progression, mortality and progression-free survival. A statistical model incorporating the progression index demonstrated the capacity to distinguish disease progression at 12 months, which was increased beyond the clinical GAP (gender, age and physiology) score model alone in all cohorts, and significantly so within the incidence-based TLF and PROFILE cohorts. Conclusion: A panel of circulatory biomarkers can provide potentially valuable clinical assistance in the prognosis of IPF patients.
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In combination with ICAM-1, OPN and periostin, MMP7 was found to be superior to the clinical GAP score in predicting progression at 12 months.
“In combination with ICAM-1, OPN and periostin (POSTN), MMP7 was recently found to be superior to the clinical GAP score in predicting progression at 12 months (Clynick et al., 2022).”
From Pulmonary fibrosis: Emerging diagnostic and therapeutic strategies (2023) · cites this paper as Clynick et al., 2022
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“Second, in an effort to better understand the connection between molecular pathways and clinical manifestations, we examined each of the clinical measures of progression independently, instead of using the composite measure of FVC, DLCO, and/or death to define a progressive disease (40).”
MethodResultPredictive biomarkers of disease progression in idiopathic pulmonary fibrosis
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“When the GAP index is combined with the aforementioned PI in a statistical model, it can better predict the disease progression of IPF patients at 12 month [6].”
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“The initial event is believed to involve injury to the AECs, leading to a robust inflammatory reaction that recruits various inflammatory cells, including lymphocytes, macrophages, basophils, eosinophils, and mast cells [99].”
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“Some of them have been investigated for their role as objective predictors to determine disease progression (15).”
BackgroundZheng, Q., Cox, I. A., Leigh, L., de Graaff, B., Johnston, F. H., Corte, T. J., Knibbs, L. D., Otáhal, P., Navaratnam, V. V., Campbell, J. A., et al. (2023) · Respirology · doi:10.1111/resp.14552 · Cited by 22 · see citing works
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“Mice lacking MMP7 are relatively protected from bleomycin-induced fibrosis [28], and increased blood levels of MMP7 have been shown to distinguish IPF patients from controls and other diseases [29] and are the most validated markers of increased mortality in IPF [30, 31].”
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“demonstrated that aggregating known potential biomarkers into a progression index may provide additional utility in predicting disease course.(54) Combining osteopontin, MMP7, intercellular adhesion molecule-1 and periostin in this progression index accurately predicted progression, stability and mortality in three in…”
BackgroundResearch Progress of Fibroblasts in Human Diseases
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“The investigators developed a statistical model incorporating these four biomarkers which was able to predict risk of disease progression in each cohort (58).”
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“Notably, previous studies have demonstrated that several circulatory molecules are associated with IPF progression [10, 11] and mortality [11, 12], suggesting that circulatory biomarkers may identify a response to antifibrotic therapy before changes in lung function or radiology are evident [13–15].”
InfluentialSelf-citationAcute exacerbation of idiopathic pulmonary fibrosis a narrative review primary focus on treatments
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“Biomarkers could significantly enhance the diagnostic process, enabling earlier detection and more personalized treatment plans [21, 22].”
Osteopontin: an essential regulatory protein in idiopathic pulmonary fibrosis
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Osteopontin as a Biomarker in Interstitial Lung Diseases
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“This composite index might increase the predictive capacity of the clinical gender–age–physiology (GAP) index alone [35].”
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“In IPF, a progression index based on 4 biomarkers (osteopontin— OPN, matrix metallopeptidase-7—MMP-7, intercellular adhesion molecule-1—ICAM1, and periostin—POSTN) was found to be superior to the clinical GAP score (gender, age, and lung physiology) in predicting progression at 12 months (37).”
MethodCirculating biomarkers and progression of idiopathic pulmonary fibrosis: data from the INMARK trial
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“In another study, an index based on concentrations of osteopontin, periostin, ICAM-1 and MMP-7 in combination with the GAP (gender, age and physiology) score more accurately predicted disease progression at 12 months than the GAP score alone [23].”
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“Development of biomarkers with high fidelity to disease activity is a major need in the field, with active research into characteristic transcriptional, proteomic, and metabolic signatures that predict disease progression [6–8].”
Treatable traits in interstitial lung disease: a narrative review
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“3,9 This has now been recognised across many ILD subtypes including CTD-ILD and chronic HP. 3,68,69 In line with ATS/ERS/JRS/ ALAT guidelines, PPF involves two or more of (a) worsening respiratory symptoms, (b) physiological deterioration with absolute decline in FVC% predicted ⩾ 5% or decline in…”
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“Interestingly, the serum biomarkers included in the LOCCM index have been previously implicated in the pathological process of pulmonary fibrosis or in reflecting damage to alveolar epithelial cell in pulmonary fibrosis-related disorders [29, 32–35].”
Establishment and application of the BRP prognosis model for idiopathic pulmonary fibrosis
Cheng, X., Feng, Z., Pan, B., Liu, Q., Han, Y., Zou, L., Rong, P., & Meng, J. (2023) · Journal of Translational Medicine · doi:10.1186/s12967-023-04668-5 · Cited by 5 · see citing works
Predicting and Treating Pulmonary Fibrosis with Proteomic Biomarker Investigations
Raineri, G., Samarelli, A. V., Tonelli, R., Masciale, V., Aramini, B., Petrachi, T., Bruzzi, G., Gozzi, F., Trasforini, E., Esposito, A., et al. (2025) · Biomedicines · doi:10.3390/biomedicines13112656 · Cited by 4 · see citing works
“A crucial clinical need in IPF is the identification of reliable biomarkers for early detection, disease staging, prognosis, and therapeutic monitoring [5].”
InfluentialPugashetti, J. V., Kim, J. S., Combs, M. P., Ma, S., Adegunsoye, A., Linderholm, A., Strek, M. E., Chen, C., Dilling, D. F., Whelan, T. P. M., et al. (2024) · The Journal of Heart and Lung Transplantation · doi:10.1016/j.healun.2024.03.018 · Cited by 4 · see citing works
PET imaging of platelet derived growth factor receptor β in lung fibrosis
Wegrzyniak, O., Lechi, F., Rokka, J., Mitran, B., Zhang, B., Thelander, U., Löfblom, J., Frejd, F. Y., Korsgren, O., Perchiazzi, G., et al. (2025) · EJNMMI Radiopharmacy and Chemistry · doi:10.1186/s41181-025-00366-3 · Cited by 5 · see citing works
Sakashita, A., Hirano, A., Fujii, W., Bassler, K. E., Tsuji, T., Kadoya, M., Omoto, A., Hiraoka, N., Imabayashi, T., Kaneko, Y., et al. (2025) · Scientific Reports · doi:10.1038/s41598-025-17374-7 · Cited by 4 · see citing works
“Although several studies have identified biomarkers and clinical predictors of fibrosis development 9–11 , these initiatives have yet to produce reliable prognostic tools.”
Contemporary Concise Review 2022: Interstitial lung disease
Smith, D. J. F., & Jenkins, G. R. (2023) · Respirology · doi:10.1111/resp.14511 · Cited by 4 · see citing works
Samarelli, A. V., Tonelli, R., Raineri, G., Bruzzi, G., Andrisani, D., Gozzi, F., Marchioni, A., Costantini, M., Fabbiani, L., Genovese, F., et al. (2024) · Frontiers in Oncology · doi:10.3389/fonc.2023.1275346 · Cited by 4 · see citing works
Proteomic profiling of the extracellular matrix in skeletal muscle
Swandulla, D., & Ohlendieck, K. (2025) · Advances in clinical chemistry · doi:10.1016/bs.acc.2025.06.008 · Cited by 3 · see citing works
Circulating biomarkers in subjects with progressive pulmonary fibrosis: data from the INBUILD trial
Maher, T. M., Jenkins, G. R., Bonella, F., Assassi, S., Diefenbach, C., Ittrich, C., Rohr, K. B., & Kolb, M. (2025) · ERJ Open Research · doi:10.1183/23120541.00158-2025 · Cited by 4 · see citing works
Self-citationSeeliger, B., Ruwisch, J., Sand, J. M. B., Simões, F. B., Jessen, H., Boerner, E. B., Fuge, J., Sewald, K., Welte, T., Wendel‐Garcia, P. D., et al. (2025) · CHEST Journal · doi:10.1016/j.chest.2025.08.047 · Cited by 3 · see citing works
“As a secondary finding of this study, we noted that increasing levels of PRO-C6 were associated with the occurrence of AEs-IPF, one of the major drivers of mortality in patients with IPF.”
Zhou, R., Li, G., Zhong, Q., Li, X., Liu, Y.-X., Zheng, J., Huang, H., & Wu, X. (2025) · Respiratory Research · doi:10.1186/s12931-025-03418-z · Cited by 2 · see citing works
“Existing IPF prediction models mostly exhibit several limitations: (1) focused on post-diagnosis IPF outcomes [13, 14], (2) relied on conventional variables [13, 15], many of which are not routinely available in clinical settings (e.g., CT densitometry [16]), or (3) did not establish proper…”
Wan, P., Xu, T., Tian, B., Guo, G., Li, X., & Yao, L. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.813329 · Cited by 2 · see citing works
“These machine learning algorithms provided new insight in COVID19 mortality (11), progressive of idiopathic pulmonary fibrosis (12) and cancer outcomes (13).”
BackgroundLi, C., Abdurehim, A., Zhao, S., Sun, Q., Xu, J., Xie, J., & Zhang, Y. (2024) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2024.176603 · Cited by 2 · see citing works
Polat, G., Özdemir, Ö., Ermin, S., Unat, D. S., & Üçsular, F. D. (2024) · Sarcoidosis vasculitis and diffuse lung diseases · doi:10.36141/svdld.v41i2.13779 · Cited by 2 · see citing works
“Recently, more promising biomarkers in blood are evaluated to discriminate progressive disease, either with ELISA or proteomic analysis (38).”
BackgroundDiagnostic potential of genomic blood biomarkers of pulmonary fibrosis in a prospective cohort
He, D. X., Shannon, C. P., Hirota, J. A., Ask, K., Ryerson, C. J., & Tebbutt, S. J. (2024) · PLoS ONE · doi:10.1371/journal.pone.0314876 · Cited by 2 · see citing works
Ge, S., Li, Y., Li, R., Liu, J., Zhang, R., Fu, H., Tang, J., Zhang, J., Zhang, N., & Zhang, M. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2024.1497530 · Cited by 2 · see citing works
Periostin and rheumatic diseases: early insights from a systematic review and meta-analysis
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Kadushkin, A. G., Yudina, O., Lukashevich, N., Davidovskaya, Е. I., Filanyuk, V., Dziadzichkina, V. V., & Cai, X. (2025) · Scientific Reports · doi:10.1038/s41598-025-93221-z · Cited by 2 · see citing works
Bioinformatic Analyses of Potential Key Genes in the Pathogenesis of Idiopathic Pulmonary FibrosisPreprint
Wang, P., Shu, W., Yin, F., Zhang, Q., Yin, Y., Deng, Q., Zeng, F., Li, Y., & Zhang, J. (2022) · Research Square · doi:10.21203/rs.3.rs-1646754/v1 · Cited by 2 · see citing works
Point‐of‐Care Diagnostics for Rapid Disease Detection
Bhuiyan, N. H., & Hossain, M. K. (2025) · Wiley eBooks · doi:10.1002/9781394314133.ch1 · Cited by 2 · see citing works
Khan, M. A., Ghamdi, B. A., Alhamadi, M., Rajendram, R., Alyami, S., Al-Gamedi, M., Al-Harbi, A., & Al-Jahdali, H. H. (2023) · Annals of Thoracic Medicine · doi:10.4103/atm.atm_264_22 · Cited by 1 · see citing works
“Although still in its infancy, the development of biological biomarkers of several diseases is advancing rapidly.[25,26] The most dynamic system of gauging disease severity in IPF is likely to integrate biomarkers with longitudinal physiological data and changes identified on imaging.”
BackgroundShen, C., Wang, W. T., Wei, D., Yang, X., Jiang, C., Sheng, Y., Chen, Y., Sun, J., Li, X. A., Li, G., et al. (2025) · BMC Pulmonary Medicine · doi:10.1186/s12890-025-03555-7 · Cited by 1 · see citing works
“While blood biomarkers aid the assessment of diagnosis, prognosis, and treatment response, none are currently integrated into clinical decision-making [69–72].”
Wang, D., Jing, Y., Zang, D., Zhang, C., & Yu, X. (2025) · Letters in Drug Design & Discovery · doi:10.1016/j.lddd.2025.100194 · Cited by 1 · see citing works
Zhang, S.-M., Huang, M.-Z., Wang, Y.-W., Wang, X.-F., Ding, Y., Li, J. Q., Zou, X.-M., & Ma, C. (2026) · Respiratory Medicine · doi:10.1016/j.rmed.2026.108946 · Cited by 1 · see citing works
Li, S., Zhao, P., Wang, C., Xia, Y. Q., Wang, H., & Qi, W. (2023) · Journal of Immunology Research · doi:10.1155/2023/4835710 · Cited by 1 · see citing works
Lee, H. Y., Jung, S. Y., Jang, J. H., Ko, J., Kim, D.-W., Her, M., & Lee, J. H. (2023) · Life · doi:10.3390/life13112118 · Cited by 1 · see citing works
“In addition, they can be measured repeatedly and less invasively than pulmonary function [21,22].”
BackgroundClustering-aided prediction of outcomes in patients with idiopathic pulmonary fibrosis
Wang, L., Wu, P., Liu, Y., Patel, D. C., Leonard, T. B., & Zhao, H. (2024) · Respiratory Research · doi:10.1186/s12931-024-03015-6 · Cited by 1 · see citing works
“A model that combined the GAP score (based on age, sex and lung function) with a progression index based on four serum protein biomarkers selected using LASSO increased the ability to predict progression over one year compared with the GAP score alone [16].”
MethodFerreiro‐Posse, A., Granados, G. D., Salvador, S., Pilia, M. F., Espejo, D., Mesones, C. E. R., Ojanguren, Í., Muñoz, X., & Villar, A. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14061974 · Cited by 1 · see citing works
Xu, W., Zhao, Y., Li, X., Yan, S., Liu, B., Huang, M., Ma, Z., & Yang, Q. (2024) · SSRN Electronic Journal · doi:10.2139/ssrn.4819254 · Cited by 1 · see citing works
Mikolasch, T., George, P. M., Sahota, J., Nancarrow, T., Barratt, S. L., Woodhead, F., Kouranos, V., Cope, V. S. A., Creamer, A. W., Fidan, S., et al. (2022) · medRxiv · doi:10.1101/2022.04.29.22274470
Pearmain, L., Jokl, E. J., Simpson, K., Birchall, L., Ou, Y., Lawless, C., Simpson, A., Mann, L., Scott, N. A., Shah, R. D., et al. (2024) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2024.01.21.576509
Moodley, Y. P. (2024) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202403-0603ed
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“Studies have shown that combining circulating biomarker levels with the GAP score significantly improves predictive ability compared to using the GAP score alone [52].”
The Future of Precision Medicine in Interstitial Lung Disease
Adams, T. N., Patel, C., & Gulati, M. (2025) · Respiratory medicine · doi:10.1007/978-3-031-87183-2_11
Aqil, M., Rahman, S. U., Aslam, M. Z., Ahmed, M. A. A., Ahmed, A., Javaid, S., & Haq, E. U. (2025) · Pakistan Journal of Medicine and Dentistry · doi:10.36283/ziun-pjmd14-2/059
The clinical utility of elevated monocyte count in patients with fibrotic interstitial lung disease
Min, B., Marinescu, D.-C., Assayag, D., Fisher, J. H., Khalil, N., Kolb, M. R. J., Manganas, H., Marcoux, V. S., Fahy, W. A., Johnson, S. R., et al. (2025) · ERJ Open Research · doi:10.1183/23120541.00259-2025
“Peripheral blood monocytes can migrate to lung tissue during injury and inflammation [14 – 16] and are thought to be the origin of SPP1/osteopontin-expressing fibrotic macrophages [17]; osteopontin levels are associated with poor outcomes in IPF [18].”
Self-citationSummer, R. S., Todd, J. L., Neely, M. L., Lobo, L. J., Namen, A. M., Newby, L. K., Shafazand, S., Suliman, S. A., Heßlinger, C., Keller, S., et al. (2024) · Figshare · doi:10.6084/m9.figshare.25067232
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“…frameworks will likely incorporate composite endpoints integrating radiomic features, circulating biomarkers, functional metrics, and patient-reported outcomes (e.g., cough and dyspnea) [30–33], aiming to more sensitively detect treatment effects and identify subgroups most likely to benefit.”
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Markers of microvascular instability predict severity and survival in idiopathic pulmonary fibrosis
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- Authors
- Clynick, B., Corte, T. J., Jo, H. E., Stewart, I., Glaspole, I. N., Grainge, C., Maher, T. M., Navaratnam, V., Hubbard, R., Hopkins, P. M. A., Reynolds, P. N., Chapman, S., Zappala, C., Keir, G. J., Cooper, W. A., Mahar, A. M., Ellis, S., Goh, N. S., De Jong, E., Cha, L., Tan, D. B. A., Leigh, L., Oldmeadow, C., Walters, E. H., Jenkins, R. G., & Moodley, Y.
- Affiliations
- The University of Western Australia (AU)
- The University of Sydney (AU)
- University of Nottingham (GB)
- The Alfred Hospital (AU)
- John Hunter Hospital (AU)
- University of Southern California (US)
- Nottingham University Hospitals NHS Trust (GB)
- The University of Queensland (AU)
- Royal Adelaide Hospital (AU)
- Royal Prince Alfred Hospital (AU)
- Austin Hospital (AU)
- Hunter Medical Research Institute (AU)
- University of Tasmania (AU)
- ORCID
- Clynick, Britt
- Corte, Tamera J.
- Jo, Helen E.
- Stewart, Iain
- Glaspole, Ian N.
- Grainge, Christopher
- Maher, Toby M.
- Navaratnam, Vidya
- Hubbard, Richard
- Hopkins, Peter M.A.
- Reynolds, Paul N.
- Chapman, Sally
- Zappala, Christopher
- Keir, Gregory J.
- Cooper, Wendy A.
- Mahar, Annabelle M.
- Ellis, Samantha
- Goh, Nicole S.
- Tan, Dino B.A.
- Leigh, Lucy
- Oldmeadow, Christopher
- Walters, E. Haydn
- Moodley, Yuben
- Venue
- European Respiratory Journal
- Publisher
- European Respiratory Society (ERS)
- Published
- 2021-10-21
- Volume
- 59
- Issue
- 3
- Pages
- 2101181
- ISSN
- 0903-1936 (ISSN-L)
- 1399-3003
- OpenAlex
- W3206852526
- Cited by
- 86
- References
- 31
- Citations by year
- 2026: 9 · 2025: 27 · 2024: 21 · 2023: 22 · 2022: 7
- FWCI
- 8.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Respiratory Journal (publishedVersion)
- UWA Profiles and Research Repository (UWA) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Spiral (Imperial College London) (submittedVersion)
- NOVA (University of Newcastle Australia) (submittedVersion)
- Funders
- National Health and Medical Research Council (APP1066128, APP1147776, GNT116371)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Occupational and environmental lung diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- idiopathic pulmonary fibrosis, serum biomarkers, disease progression, prognostic factors, osteopontin, ICAM-1, periostin, progression index, GAP score, mortality, progression-free survival, proteomics
- MeSH terms
- Australia, Humans, Prospective Studies, Retrospective Studies, Biomarkers, Proteomics, Idiopathic Pulmonary Fibrosis
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