---
title: "Serum periostin as a postmortem biomarker for acute myocardial infarction"
id: "plos-one-2-serum-periostin-levels-in-myocardial-infarction-findings-from-forensic-autopsy"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-2-serum-periostin-levels-in-myocardial-infarction-findings-from-forensic-autopsy"
content_type: "clinical_feed_article"
specialty: "Cardiology"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533"
published_at: "2026-08-17T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Serum periostin as a postmortem biomarker for acute myocardial infarction
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/plos-one-2-serum-periostin-levels-in-myocardial-infarction-findings-from-forensic-autopsy
- **Specialty:** [Cardiology](https://medichelpline.com/clinical-feed/cardiology.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533)
- **Published At:** 2026-08-17T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- This forensic autopsy study measured **serum periostin** in 80 cases categorized as acute myocardial infarction (AMI, n=46), fatal asthma (n=16), and traumatic death (n=18). Results provide baseline postmortem periostin concentrations for these groups. - Median serum periostin was substantially higher in AMI (728.50 ng/mL, IQR 465.25–1139.75) than in asthma (410.50 ng/mL, IQR 253.00–756.00) or trauma (386.50 ng/mL, IQR 229.75–532.50). - Periostin levels in the trauma control group showed no significant correlation with postmortem interval (r = −0.058, p = 0.82), suggesting relative stability over PM intervals studied (range 11–84 h). - In AMI cases, serum periostin did not correlate significantly with age, body mass index, or heart weight, nor did levels differ significantly by sex or by histories of diabetes, dyslipidemia, or hypertension. - No significant differences in periostin were found by culprit coronary artery (LAD, LCx, RCA), primary infarct region, or presence versus absence of fibrotic scarring attributable to prior MI. - Receiver operating characteristic (ROC) analysis using a cut-off of 556 ng/mL yielded sensitivity 93.8%, specificity 67.4%, and AUC 0.814 (95% CI 0.708–0.920), with PPV 0.939 and NPV 0.516 reported. - The authors conclude that serum periostin may assist postmortem evaluation of AMI by providing discriminative values between AMI and noncardiac traumatic deaths; findings supply baseline periostin data for forensic settings. - The study used right atrial appendage blood, excluded hemolyzed samples, stored serum at −80 °C, and measured periostin by ELISA through an outsourced laboratory. Ethical approval and consent procedures were described. - Details on some potential confounders, broader postmortem stability beyond reported PM intervals, and external validation were not reported in the source beyond what is summarized here.
## Clinical Analysis & Structured Key Points
[ Skip to main content ](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#main-content) Advertisement * [plos.org](https://plos.org/) * [Create account](https://community.plos.org/registration/new) * [Sign in](https://journals.plos.org/user/secure/login?page=%2Fplosone%2Farticle%3Fid%3D10.1371%2Fjournal.pone.0356533) * * About * Browse * Publish * [](https://journals.plos.org/plosone/ "PLOS One") * Search [advanced search](https://journals.plos.org/plosone/search) * [Browse Topics](https://journals.plos.org/plosone/subjectAreaBrowse) Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click [here](https://github.com/PLOS/plos-thesaurus/blob/master/README.md "Link opens in new window"). [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533) [](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533) * 0 [Save](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356533#savedHeader) [Total Mendeley and Citeulike bookmarks.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356533#savedHeader) * 0 [Citation](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356533#citedHeader) [Paper's citation count computed by Dimensions.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356533#citedHeader) * 18 [View](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356533#viewedHeader) [PLOS views and downloads.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356533#viewedHeader) * 0 [Share](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356533#discussedHeader) [Sum of Facebook, Twitter, Reddit and Wikipedia activity.](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356533#discussedHeader) Open Access Peer-reviewed Research Article # Serum periostin levels in myocardial infarction: Findings from forensic autopsy cases * Atsushi Yamada , Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Validation, Writing – original draft, Writing – review & editing * E-mail: yamada.a.2386@m.isct.ac.jp Affiliations Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo (ST), Tokyo, Japan, Department of Legal Medicine, Kyorin University School of Medicine, Tokyo, Japan [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0001-7598-5877 ](https://orcid.org/0000-0001-7598-5877 "ORCID Registry") ⨯ * Kana Unuma, Roles Formal analysis, Validation, Writing – review & editing Affiliation Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo (ST), Tokyo, Japan [ ![ORCID logo](https://journals.plos.org/resource/img/orcid_16x16.png) https://orcid.org/0000-0002-1241-5217 ](https://orcid.org/0000-0002-1241-5217 "ORCID Registry") ⨯ * Osamu Kitamura Roles Investigation, Resources, Supervision, Writing – review & editing Affiliation Department of Legal Medicine, Kyorin University School of Medicine, Tokyo, Japan ⨯ # Serum periostin levels in myocardial infarction: Findings from forensic autopsy cases * Atsushi Yamada, * Kana Unuma, * Osamu Kitamura ![PLOS](https://journals.plos.org/resource/img/logo-plos-full-color.svg) x * Published: August 17, 2026 * * [Article](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533) * [Authors](https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0356533) * [Metrics](https://journals.plos.org/plosone/article/metrics?id=10.1371/journal.pone.0356533) * [Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0356533) * [Media Coverage](http://plos.altmetric.com/details/doi/10.1371/journal.pone.0356533) * [Abstract](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#abstract0) * [1. Introduction](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#sec001) * [2. Methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#sec002) * [3. Results](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#sec009) * [4. Discussion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#sec016) * [5. Conclusion](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#sec024) * [References](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#references) * [Reader Comments](https://journals.plos.org/plosone/article/comments?id=10.1371/journal.pone.0356533) * [Figures](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533) ## Abstract Acute myocardial infarction (AMI) remains one of the leading causes of sudden death with significant implications in both clinical and forensic practice. In forensic settings, AMI diagnosis traditionally relies on gross and histopathological findings. However, when ischemic changes are subtle or insufficiently developed, various cardiac biomarkers have been investigated to support postmortem diagnosis. Periostin, a matricellular protein involved in tissue remodeling and repair, has recently garnered attention for its role in cardiac pathology. Emerging evidence suggests that serum periostin may be a valuable biomarker for assessing cardiac injury and predicting outcomes after AMI. This study aimed to evaluate serum periostin levels in forensic autopsy cases of AMI. The subjects were 80 autopsy cases, categorized into AMI (n = 46), fatal asthma (n = 16), and traumatic deaths (n = 18). Serum periostin levels were significantly elevated in AMI compared with asthma and trauma cases, with median values of 728.50 ng/mL (IQR 465.25–1139.75) in AMI, 410.50 ng/mL (IQR 253.00–756.00) in asthma, and 386.50 ng/mL (IQR 229.75–532.50) in trauma. Serum periostin showed no significant correlation with postmortem interval and was minimally influenced by patients’ characteristics or comorbidities. These findings provide baseline data on serum periostin levels in forensic autopsy cases and suggest that periostin measurement may assist in the postmortem evaluation of AMI. ## Figures ![Fig 5](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356533.g005) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356533.t001) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356533.g001) ![Fig 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356533.g002) ![Fig 3](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356533.g003) ![Table 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356533.t002) ![Fig 4](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356533.g004) ![Fig 5](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356533.g005) ![Table 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356533.t001) ![Fig 1](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356533.g001) ![Fig 2](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356533.g002) **Citation:** Yamada A, Unuma K, Kitamura O (2026) Serum periostin levels in myocardial infarction: Findings from forensic autopsy cases. PLoS One 21(8): e0356533. https://doi.org/10.1371/journal.pone.0356533 **Editor:** Yoshiaki Taniyama, Osaka University Graduate School of Medicine, JAPAN **Received:** March 25, 2026; **Accepted:** August 4, 2026; **Published:** August 17, 2026 **Copyright:** © 2026 Yamada et al. This is an open access article distributed under the terms of the [Creative Commons Attribution License](http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. **Data Availability:** All relevant data generated or analyzed during this study are included in the manuscript. **Funding:** The author(s) received no specific funding for this work. **Competing interests:** The authors have declared that no competing interests exist. ## 1. Introduction Acute myocardial infarction (AMI) remains a major cause of sudden death with significant implications in both clinical and forensic practice. In forensic settings, AMI diagnosis primarily relies on gross and histopathological findings. However, when ischemic changes are insufficiently developed, these morphological indicators may be inconclusive, thus presenting a substantial diagnostic challenge [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref001)]. To overcome these limitations, various cardiac biomarkers have been investigated to support postmortem diagnosis. Among them, cardiac troponin T and I (cTnT and cTnI) measured in serum or pericardial fluid have gained acceptance as valuable tools for AMI diagnosis [[1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref001)–[3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref003)]. Furthermore, recent studies have demonstrated that combining multiple biomarkers such as cTnI, creatine kinase MB (CK-MB), B-type natriuretic peptide (BNP), lactate dehydrogenase (LDH), and α-hydroxybutyrate dehydrogenase improves diagnostic accuracy [[2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref002)]. Reliable biomarkers that remain stable in forensic settings and are minimally affected by postmortem changes would therefore be particularly valuable in forensic investigations [[4](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref004),[5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref005)]. Periostin, a multifunctional matricellular protein initially identified as osteoblast-specific factor 2, is a secreted extracellular matrix (ECM) protein that plays a critical role in tissue remodeling and repair [[6](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref006)–[9](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref009)]. Increasing evidence suggests that periostin is involved in cardiac pathology, particularly in the structural and functional remodeling of the myocardium after AMI [[10](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref010)–[12](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref012)]. From a diagnostic perspective, serum periostin has recently emerged as a potential biomarker for predicting the prognosis and treatment response after AMI [[13](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref013)–[19](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref019)]. However, its relevance in forensic settings has not been well characterized. Additionally, periostin is implicated in airway remodeling through type 2 helper T (Th2) inflammation and has been proposed as an indicator of disease activity and control in bronchial asthma [[20](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref020)–[22](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref022)]. Considering these properties, this study aimed to evaluate serum periostin levels in forensic autopsy cases and provide baseline data on its potential applicability in postmortem investigations. ## 2. Methods ### 2.1. Subjects The characteristics of the study subjects are summarized in [Table 1](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone-0356533-t001). This study included 80 patients who underwent a medicolegal autopsy at our institution between 01/04/2015 and 31/08/2025. Subjects were categorized based on the cause of death as 1) AMI, 2) fatal asthma, and 3) traumatic death due to accident or suicide. [![thumbnail](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356533.t001)](https://journals.plos.org/plosone/article/figure/image?size=medium&id=10.1371/journal.pone.0356533.t001 "Click for larger image") Download: * [PNG larger image](https://journals.plos.org/plosone/article/figure/image?download&size=large&id=10.1371/journal.pone.0356533.t001) * [TIFF original image](https://journals.plos.org/plosone/article/figure/image?download&size=original&id=10.1371/journal.pone.0356533.t001) Table 1. Characteristics of the study subjects (n = 80). [ https://doi.org/10.1371/journal.pone.0356533.t001](https://doi.org/10.1371/journal.pone.0356533.t001) We selected cases of AMI in which both the culprit artery and myocardial histopathological changes were identified. The presence of a coronary thrombus and thin-cap fibroatheroma in the left anterior descending artery (LAD), left circumflex artery (LCx), or right coronary artery (RCA) was confirmed. Three to four horizontal cross-sections from the apex to the mid-ventricle were macroscopically examined. Short-axis sections of the coronary arteries were also evaluated. To identify the primary infarct region, histopathological examination was performed by dividing the myocardium into five distinct regions ([Fig 1A](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone-0356533-g001)): anterior wall of the left ventricle (LVAW), lateral wall of the left ventricle (LVLW), posterior wall of the left ventricle (LVPW), interventricular septum (IVS), and right ventricular wall (RVW). Each region was assessed individually to determine the presence and extent of early ischemic changes. Histopathological evidence of ischemic changes was supported by findings, including coagulation necrosis characterized by loss of cross-striations, contraction band formation, interstitial edema, hemorrhage, and early neutrophilic infiltration; progressive coagulation necrosis with nuclear pyknosis and marginal contraction bands; and ultimately, complete loss of nuclei and cross-striations accompanied by extensive neutrophilic infiltration ([Fig 1B](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone-0356533-g001), [C](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone-0356533-g001)). If a thrombus was identified in the coronary artery, it was subjected to histopathological examination, primarily to exclude vasculitis involvement ([Fig 1D](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone-0356533-g001)). Furthermore, cases with fibrotic replacement of myocardial tissue attributable to recurrent myocardial infarction (re-MI) were assessed and classified according to the presence or absence of fibrotic scarring ([Fig 1E](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone-0356533-g001)). To analyze the relationship between serum periostin levels and the anatomical characteristics of MI, we compared periostin concentrations according to both the culprit coronary artery and the primary infarct region among AMI cases (n = 46). Cases presumed to involve fatal arrhythmia, characterized by only coronary artery stenosis due to stable plaques without morphological abnormalities of the myocardium, were excluded from this study. [![thumbnail](https://journals.plos.org/plosone/article/figure/image?size=inline&id=10.1371/journal.pone.0356533.g001)](https://journals.plos.org/plosone/article/figure/image?size=medium&id=10.1371/journal.pone.0356533.g001 "Click for larger image") Download: * [PNG larger image](https://journals.plos.org/plosone/article/figure/image?download&size=large&id=10.1371/journal.pone.0356533.g001) * [TIFF original image](https://journals.plos.org/plosone/article/figure/image?download&size=original&id=10.1371/journal.pone.0356533.g001) Fig 1. Representative findings of AMI used for diagnostic criteria and sampling. (A) Horizontal cross-section of AMI case showing five myocardial regions (LVAW, LVLW, IVS, RVW) outlined, and LCx with a coronary thrombus identified and sampled. (B) Histological features of early ischemic injury, including wavy myocardial fibers without inflammatory infiltration, interstitial edema, and hemorrhage (H&E stain). (C) Advanced ischemic injury with extensive neutrophilic infiltration (H&E stain). (D) Coronary artery thrombus in LCx (EVG stain). (E) Example of myocardium without fibrotic scarring, evaluated by EVG stain for re-MI assessment. AMI, acute myocardial infarction; LAD, left anterior descending artery; LCx, left circumflex artery; RCA, right coronary artery; LVAW, anterior wall of the left ventricle; LVLW, lateral wall of the left ventricle; LVPW, posterior wall of the left ventricle; IVS, interventricular septum; RVW, right ventricular wall; H&E, Hematoxylin and eosin; EVG, Elastic Van Gieson; re-MI, recurrent myocardial infarction. [ https://doi.org/10.1371/journal.pone.0356533.g001](https://doi.org/10.1371/journal.pone.0356533.g001) Asthma was diagnosed based on specific findings and pre-mortem symptoms [[23](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref023),[24](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0356533#pone.0356533.ref024)]. Traumatic deaths were used as the reference group because they were considered unlikely to involve systemic inflammatory or fibrotic conditions that may influence serum periostin levels. Traumatic deaths included falls from height, falling down, traffic accidents, blunt assault-related homicides, and self-inflicted stabbings. In both the asthma and trauma groups, individuals with evidence of coronary atherosclerosis or MI were excluded. Furthermore, all study subjects underwent comprehensive macroscopic and histopathological examinations of multiple organs, including the brain, heart, lungs, liver, kidneys, spleen, pancreas, pituitary gland, thyroid gland, thymus, adrenal glands, gastrointestinal tract, aorta, and reproductive organs. Cases were screened to exclude those with evidence of atopic dermatitis, neoplasm, aneurysmal disease, and diseases primarily characterized by fibrosis, such as pulmonary fibrosis and systemic sclerosis. Two forensic pathologists comprehensively evaluated all cases, including one author with subspecialty expertise in dermatology. The number of subjects (women/men) was as follows: AMI, 46 (6/40); asthma, 16 (4/12); and trauma, 18 (5/13). The mean ± standard deviation (SD) ages of the subjects were as follows: AMI, 57.28 ± 17.18 years; asthma, 56.31 ± 16.08 years; and trauma, 58.06 ± 22.51 years. The mean ± SD body mass index (BMI) of the subjects was as follows: AMI, 25.97 ± 5.75; asthma, 22.43 ± 4.43; and trauma, 21.25 ± 4.55. The mean ± SD heart weight of the subjects was as follows: AMI, 467.67 ± 109.45 g; asthma, 359.00 ± 68.72 g; and trauma, 367.22 ± 106.27 g. The mean ± SD PM intervals of the subjects were as follows: AMI, 30.98 ± 17.75 h; asthma, 35.00 ± 20.32 h; and trauma, 34.50 ± 21.10 h. Written informed consent to use individual data for academic publication was obtained from the bereaved family, ensuring the utmost respect for privacy and confidentiality. All data we
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