CC-chemokine ligand 18, CXC motif chemokine 13 and osteopontin as biomarkers of silicosis and asbestosis: a prospective observational study

Our plain-English summary of CC-chemokine ligand 18, CXC motif chemokine 13 and osteopontin as biomarkers of silicosis and asbestosis: a prospective observational study, by N. Wu, C. Xue, S. Yu, et al (Scientific Reports, 2025).

The study

• Authors: N. Wu, C. Xue, S. Yu, Y. Wang, D. Sun, Q. Ye
• Journal: Scientific Reports
• Published: 2025;15(1):6819
• Read it: PubMed · Publisher · Free full text

Abstract

Silicosis and asbestosis, distinct forms of pneumoconiosis, manifest progressive interstitial fibrosis due to exposure to silica dust or asbestos fibers. This study aimed to identify potential biomarkers for diagnosing silicosis and asbestosis, while also evaluating disease severity and prognosis. We undertook an prospective observational study involving patients with silicosis or asbestosis. The correlation between baseline CC-chemokine ligand 18 (CCL18), CXC motif chemokine 13 (CXCL13), osteopontin (OPN), periostin, and fibulin-3 and clinical variables was analyzed. Diagnostic sensitivity was evaluated using receiver operating characteristic curves, and correlations between baseline biomarker levels and disease severity were analyzed. Multivariable Cox regression assessed the baseline concentrations' strength in predicting all-cause mortality for silicosis and asbestosis. Of 231 silicosis and 163 asbestosis included in the study, 29 silicosis (12.6%) and 28 (17.2%) asbestosis died within the five years follow-up period. Elevated baseline concentrations of CCL18, CXCL13, and OPN were observed in 231 silicosis patients and 163 asbestosis patients compared to 118 HCs. Diagnostic accuracy for silicosis or asbestosis, in order, was CCL18, OPN, and CXCL13. Combining CCL18, OPN, and CXCL13 enhanced diagnostic accuracy. In silicosis patients, these concentrations were significantly associated with lung function values. However, these biomarkers were not the risk factor for all-cause mortality. CCL18, CXCL13, and OPN stand out as promising biomarkers for diagnosing silicosis and asbestosis. Meanwhile, CCL18, CXCL13, and OPN may be used for the evaluation of silicosis conditions.

© 2025. The Author(s).

In plain English

This prospective study at Beijing Chao-Yang Hospital, China, measured five blood proteins in 231 newly diagnosed silicosis patients, 163 asbestosis patients exposed to chrysotile dust, and 118 healthy volunteers without occupational dust exposure. Compared with healthy volunteers, CCL18, CXCL13 and osteopontin (OPN) were significantly higher in both patient groups. Fibulin-3 did not differ significantly. CCL18 best distinguished patients from healthy volunteers, followed by OPN, then CXCL13. Combining all three proteins gave 90.1% sensitivity and 89.3% specificity for asbestosis. In asbestosis patients, the three proteins did not differ significantly by disease stage and were not correlated with lung function. In silicosis patients, all three were negatively correlated with two lung-function measures, and CCL18 and OPN were higher in stage III than earlier stages. Over a median follow-up of 41.9 months, 28 of the 163 asbestosis patients died. After adjustment, age and respiratory failure were risk factors for death; OPN was not. The authors concluded the three proteins can help diagnose silicosis or asbestosis. They noted a single-centre design and that exposure levels could not be accurately assessed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Prospective cohort (observational) study of newly diagnosed pneumoconiosis patients compared with healthy controls, with follow-up for death
• Who was studied: 231 silicosis patients and 163 asbestosis patients recruited January 2018 to December 2019 at Beijing Chao-Yang Hospital, China, plus 118 healthy volunteers from the hospital's health examination center with no occupational dust exposure. The groups differed significantly in sex, age, BMI and smoking status.
• Exposure: Asbestosis patients: occupational exposure to chrysotile dust. Silicosis patients, the comparison disease group, were exposed to crystalline silica. Exposure duration in years was used as a proxy because no air measurements were available.
• Main results:
  • Plasma CCL18 and CXCL13 did not differ significantly between silicosis and asbestosis patients, but were significantly higher in both groups than in healthy controls (P less than 0.01).
  • Plasma OPN was significantly higher in both silicosis and asbestosis patients than in healthy controls (both P less than 0.01). It was also higher in silicosis than in asbestosis patients.
  • Plasma fibulin-3 did not differ significantly among silicosis patients, asbestosis patients and healthy controls.
  • Asbestosis versus healthy controls, adjusted odds ratios: CCL18 1.14 (95% CI 1.078 to 1.200), CXCL13 1.09 (95% CI 1.053 to 1.136), OPN 1.05 (95% CI 1.028 to 1.076).
  • By area under the ROC curve, diagnostic accuracy for distinguishing patients from healthy controls ranked CCL18 first, then OPN, then CXCL13.
  • Combining all three biomarkers gave sensitivity 93.1% and specificity 89.1% for silicosis, and sensitivity 90.1% and specificity 89.3% for asbestosis.
  • In asbestosis patients, CCL18, CXCL13 and OPN levels did not differ significantly across disease stages.
  • In silicosis patients, CCL18 and OPN, but not CXCL13, were significantly higher in Stage III than in Stage I or Stage II.
  • In silicosis patients, CCL18, CXCL13 and OPN levels were negatively correlated with predicted FVC% and DLCO SB% (P less than 0.05).
  • In asbestosis patients, CCL18, CXCL13 and OPN levels were not correlated with lung function values.
  • Follow-up ran to the end of December 2022, with a median of 41.9 months (range 1 to 60).
  • Of 163 asbestosis patients, 28 died and 9 were lost to follow-up.
  • Of 231 silicosis patients, 29 died and 6 were lost to follow-up.
  • After adjustment for covariates, age and respiratory failure were risk factors for all-cause mortality; OPN was not.
• The authors' conclusion: The authors concluded that CCL18, CXCL13 and OPN can serve as biomarkers to help diagnose silicosis or asbestosis, and showed promise for assessing the severity of silicosis. They did not find these biomarkers to be risk factors for all-cause mortality.
• Limitations the authors state:
  • Patients came from a single medical centre, so there may be selection bias, and the cohort may not represent all silicosis and asbestosis patients.
  • There was no control group of age- and sex-matched dust-exposed workers without disease.
  • Without air measurements or detailed exposure-frequency data, exposure levels could not be accurately assessed.
  • Biomarkers were measured only at baseline, not repeatedly, so changes during disease progression were not evaluated.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Osteopontin, Biomarker, Silicosis, Pneumoconiosis, Interstitial Fibrosis, Prognosis, Fibulin-3.

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