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Kostopoulou E, Kalavrizioti D, Davoulou P, Sinopidis X, Papachristou E, Goumenos DS, Dimitriou G, Spiliotis BE, Papasotiriou M. Soluble urokinase plasminogen activator receptor (suPAR) in children with obesity or type 1 diabetes as a marker of endothelial dysfunction: a cross-sectional study. Eur J Pediatr 2024; 183:2383-2389. [PMID: 38448612 DOI: 10.1007/s00431-024-05496-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
Pediatric obesity and type 1 diabetes mellitus (T1DM) represent two common chronic diseases associated with chronic inflammation, endothelial dysfunction and long-term complications. The aim of the present study was to assess the possible diagnostic and prognostic value of soluble urokinase plasminogen activator receptor (suPAR), a marker of inflammation and impaired endothelial function, in children with the diseases. In this cross-sectional study, children and adolescents with T1DM (N = 41) or obesity (N = 37), aged < 18 years old, and without proteinuria were included, together with children of similar age and without evident morbidity that served as controls (N = 42). Serum samples were obtained during standard outpatient follow up and the urokinase-type plasminogen activator receptor (suPAR) concentrations were measured using a commercially available sandwich ELISA kit (DUP00, R&D systems). Clinical and biochemical indices that were also assessed include body mass index (BMI) z-score, Tanner stages, glycosylated haemoglobin (HbA1c), fasting lipid profile and serum creatinine. Mean serum suPAR levels were significantly higher in patients with obesity compared to patients with T1DM and controls, while children with T1DM had similar suPAR levels to controls. Also, serum suPAR levels showed a negative correlation with age (Spearman rho -0.359, p < 0.001) and serum creatinine levels (Spearman rho -0.334, p = 0.005), and a positive correlation with BMI z-score (Spearman rho 0.354, p = 0.009) in the whole cohort. Conclusion: Serum suPAR may be a useful predictive marker of inflammation or endothelial dysfunction for children with obesity and T1DM, as well as a promising therapeutic target. Further studies are needed in order to clarify whether the reported differences in suPAR levels could reflect a greater impairment of the inflammation status and endothelial function in children with obesity compared to children with T1DM. What is Known: • Paediatric obesity and type 1 diabetes are characterised by chronic inflammation and metabolic dysregulation. • Urokinase plasminogen activator receptor (uPAR) has been proposed as a useful biomarker for chronic inflammation and cardiovascular risk in adults. What is New: • Serum suPAR levels were increased in children and adolescents with obesity compared to those with T1DM and healthy controls; thus, obesity may affect the inflammatory status and endothelial function to a higher degree than T1DM during childhood. • Serum suPAR may serve as a diagnostic and predictive marker of inflammation and endothelial dysfunction for children and adolescents with obesity and T1DM.
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Affiliation(s)
| | - Dimitra Kalavrizioti
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, 26504, Greece
| | - Panagiota Davoulou
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, 26504, Greece
| | | | - Evangelos Papachristou
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, 26504, Greece
| | - Dimitrios S Goumenos
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, 26504, Greece
| | - Gabriel Dimitriou
- Department of Pediatrics, University Hospital of Patras, Patras, Greece
| | | | - Marios Papasotiriou
- Department of Nephrology and Kidney Transplantation, University Hospital of Patras, Patras, 26504, Greece.
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İşsever K, Dheir H. The Relationship Between Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR) Levels and Treatment Response in Patients With Glomerulonephritis: A Single-Center Experience. Cureus 2023; 15:e47473. [PMID: 38021795 PMCID: PMC10662779 DOI: 10.7759/cureus.47473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Aim Soluble urokinase-type plasminogen activator receptor (suPAR) is an important protein that is reported to increase in a broad range of inflammatory processes. We aimed to determine whether suPAR is a significant biomarker in glomerulonephritis for distinguishing patients with treatment response from patients without treatment response in our study. Materials and methods This was a prospective study in which 117 patients with biopsy-proven glomerulonephritis and 54 healthy individuals without a known chronic disease (control group) were enrolled. A total of 117 patients were divided into two groups: "treatment responsive" and "treatment nonresponsive." Blood samples were collected from the patients upon their outpatient clinic visits, and the demographical and lab parameters were compared between the groups. Results For the patient group consisting of 117 individuals, 56.4% were male, the mean age was 49.6 years, and the mean follow-up duration was 32.2 months. The most commonly diagnosed glomerular disease was focal segmental glomerulosclerosis (FSGS), followed by IgA nephropathy and membranoproliferative glomerulonephritis, respectively. While suPAR levels were significantly higher in the patient group (166.06 ± 127.66 vs. 119.67 ± 70.53 pg/ml, p = 0.001) (suPAR level ± standard deviation), no significant relationship was found between suPAR levels, treatment response status, and disease severity. Besides, there was no significant relationship between suPAR levels and proteinuria levels, BMI of the patients, and the type of immunosuppressive agent used in the treatment and BMI. Conclusion Our study showed that suPAR levels could distinguish a patient with glomerulonephritis from a healthy individual, whereas it has no value in predicting the disease progression and treatment responsiveness.
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Affiliation(s)
- Kubilay İşsever
- Internal Medicine, Giresun University Faculty of Medicine, Giresun, TUR
| | - Hamad Dheir
- Nephrology, Sakarya University Faculty of Medicine, Sakarya, TUR
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Kotsiou OS, Pantazopoulos I, Mavrovounis G, Marsitopoulos K, Tourlakopoulos K, Kirgou P, Daniil Z, Gourgoulianis KI. Serum Levels of Urokinase Plasminogen Activator Receptor (suPAR) Discriminate Moderate Uncontrolled from Severe Asthma. J Pers Med 2022; 12:jpm12111776. [PMID: 36579490 PMCID: PMC9693242 DOI: 10.3390/jpm12111776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/19/2022] [Accepted: 10/24/2022] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The most clinically useful concept in asthma is based on the intensity of treatment required to achieve good asthma control. Biomarkers to guide therapy are needed. AIMS To investigate the role of circulating levels of soluble urokinase plasminogen activator receptor suPAR as a marker for asthma severity. METHODS We recruited patients evaluated at the Asthma Clinic, University of Thessaly, Greece. Asthma severity and control were defined according to the GINA strategy and Asthma Contro Test (ACT). Anthropometrics, spirometry, fractional exhaled nitric oxide (FeNO), suPAR, blood cell count, c-reactive protein (CRP), and analyses of kidney and liver function were obtained. Patients with a history of inflammatory, infectious, or malignant disease or other lung disease, more than 5 pack years of smoking history, or corticosteroid therapy were excluded. RESULTS We evaluated 74 asthma patients (69% female, mean age 57 ± 17 years, mean body mass index (BMI) 29 ± 6 kg/m2). In total, 24%, 13%, 6%, 5%, 29% and 23% of the participants had mild well-controlled, mild uncontrolled, moderate well-controlled, moderate uncontrolled, severe well-controlled, and severe uncontrolled asthma, respectively. Overall, 67% had T2-high asthma, 26% received biologics (15% and 85% received omalizumab and mepolizumab, respectively), and 34% had persistent airway obstruction. suPAR levels were significantly lower in asthmatics with moderate uncontrolled asthma than in patients with severe uncontrolled asthma without (2.1 ± 0.4 vs. 3.3 ± 0.7 ng/mL, p = 0.023) or with biologics (2.1 ± 0.4 vs. 3.6 ± 0.8 ng/mL, p = 0.029). No correlations were found between suPAR levels and age, BMI, T2 biomarkers, CRP, or spirometric parameters. CONCLUSIONS suPAR levels were higher in asthmatics with severe disease than in those with moderate uncontrolled asthma.
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Affiliation(s)
- Ourania S. Kotsiou
- Department of Human Pathophysiology, Faculty of Nursing, University of Thessaly, 41110 Larissa, Greece
- Correspondence:
| | | | - Georgios Mavrovounis
- Department of Respiratory Medicine, University of Thessaly, 41500 Larissa, Greece
| | | | | | - Paraskevi Kirgou
- Department of Respiratory Medicine, University of Thessaly, 41500 Larissa, Greece
| | - Zoe Daniil
- Department of Respiratory Medicine, University of Thessaly, 41500 Larissa, Greece
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Serum soluble urokinase plasminogen activator receptor in adolescents: interaction of chronic pain and obesity. Pain Rep 2020; 5:e836. [PMID: 32766470 PMCID: PMC7382552 DOI: 10.1097/pr9.0000000000000836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/05/2020] [Accepted: 06/18/2020] [Indexed: 12/24/2022] Open
Abstract
Pediatric chronic pain is exacerbated by obesity. Serum soluble urokinase plasminogen activator receptor, a novel inflammation biomarker, was increased in obese adolescents with chronic pain indicating interactive inflammatory conditions. Introduction: Obesity in adolescents is increasing in frequency and is associated with short-term and long-term negative consequences that include the exacerbation of co-occurring chronic pain. Objective: To determine whether the interaction between chronic pain and obesity would be reflected in changes in serum soluble urokinase plasminogen activator receptor (suPAR) concentrations, a novel marker of systemic inflammation associated with obesity, insulin resistance, and cardiovascular disease. Methods: We measured serum suPAR levels in 146 adolescent males and females with no pain or obesity (healthy controls; n = 40), chronic pain with healthy weight (n = 37), obesity alone (n = 41), and the combination of chronic pain and obesity (n = 28). Results: Serum suPAR (median [interquartile range]) was not increased by chronic pain alone (2.2 [1.8–2.4] ng/mL) or obesity alone (2.2 [2.0–2.4] ng/mL) but was increased significantly with the combination of chronic pain and obesity (2.4 [2.1–2.7] ng/mL; P < 0.019). This finding confirms the proposition that pain and obesity are inflammatory states that display a classic augmenting interaction. Conclusion: We propose that measurement of serum suPAR can be added to the armamentarium of serum biomarkers useful in the evaluation of mechanisms of inflammation in adolescent obesity and chronic pain.
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Weidemann DK, Abraham AG, Roem JL, Furth SL, Warady BA. Plasma Soluble Urokinase Plasminogen Activator Receptor (suPAR) and CKD Progression in Children. Am J Kidney Dis 2020; 76:194-202. [PMID: 31987488 DOI: 10.1053/j.ajkd.2019.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 11/04/2019] [Indexed: 12/21/2022]
Abstract
RATIONALE & OBJECTIVE Soluble urokinase plasminogen activator receptor (suPAR) is a novel biomarker associated with incident chronic kidney disease (CKD) and has been identified as an independent risk factor for CKD progression in children, although these findings remain preliminary, limited to a single point in time, and unreplicated in pediatric cohorts. STUDY DESIGN Prospective longitudinal cohort study. SETTING & PARTICIPANTS 565 participants aged 1 to 16 years enrolled in the Chronic Kidney Disease in Children (CKiD) Study. EXPOSURE Plasma suPAR levels, categorized by quartiles, measured at study entry and a 6-month follow-up interval. OUTCOME CKD progression, defined as the initiation of kidney replacement therapy (dialysis or transplantation) or >50% decline in estimated glomerular filtrate rate (eGFR). ANALYTIC APPROACH Associations between plasma suPAR quartiles and risk for CKD progression were estimated using lognormal survival models, adjusting for potential confounders. RESULTS Participants in the highest suPAR quartile experienced 54% faster progression compared with the lowest quartile after adjustment for demographic and traditional CKD risk factors (P < 0.001). Addition of eGFR to the model attenuated the risk, although those in the highest quartile experienced 33% faster progression compared with the lowest quartile (P = 0.008). Plasma suPAR levels showed little change over 6 months. LIMITATIONS Potential for residual confounding, reliance on observational data, relatively fewer patients with higher eGFRs for subgroup analysis. CONCLUSIONS Higher suPAR levels are associated with shorter time to kidney replacement therapy or halving of eGFR in children with CKD. This association is attenuated slightly with inclusion of eGFR in regression modeling but remains a significant association for participants with the highest suPAR levels.
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Affiliation(s)
- Darcy K Weidemann
- Division of Pediatric Nephrology, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO.
| | - Alison G Abraham
- Johns Hopkins School of Medicine, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Jennifer L Roem
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Susan L Furth
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO
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YENER Y, YERLİKAYA FH. Western diet induces endogen oxidative deoxyribonucleic acid damage and infl ammation in Wistar rats. REV NUTR 2018. [DOI: 10.1590/1678-98652018000300001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective Nutritional diseases such as metabolic syndrome, cardiovascular disorder, chronic inflammation or even cancer are observed in people who sustain their lifestyle by Western diet due to high calorie intake. The origin of these diseases are the degraded deoxyribonucleic acid structure. In this study, we investigated whether Western diet produced endogenous oxidative deoxyribonucleic acid damage, apoptosis or inflammation. Methods Twenty-eight male Wistar rats, aged 10-12 weeks, were divided into four groups. The rats in control group received the standard diet and the remaining rats were given one of the following three diets for four weeks: a high-fat diet containing 35% fat, a high-sucrose diet containing 69% sucrose and Western diet comprising both two types of diets. After treatment the serum 8-hydroxy-2-deoxyguanosine, poly (adenosine diphosphate ribose) polymerase-1, chitinase-3-like protein 1, soluble urokinase-type plasminogen activator receptor, Fas ligand and cytochrome c levels were measured. Results It was observed no changes in the serum soluble urokinase-type plasminogen activator receptor, Fas ligand and cytochrome c levels whereas a statistically significant increase in the serum 8-hydroxy-2-deoxyguanosine, poly (adenosine diphosphate ribose) polymerase-1 and chitinase-3-like protein 1 levels were found only in rats that were given Western diet. Conclusion The findings show that Western diet produced endogenous oxidative deoxyribonucleic acid damage, which then increased serum poly (adenosine diphosphate ribose) polymerase-1 levels, eventually leading to inflammation.
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Schaefer F, Trachtman H, Wühl E, Kirchner M, Hayek SS, Anarat A, Duzova A, Mir S, Paripovic D, Yilmaz A, Lugani F, Arbeiter K, Litwin M, Oh J, Matteucci MC, Gellermann J, Wygoda S, Jankauskiene A, Klaus G, Dusek J, Testa S, Zurowska A, Caldas Afonso A, Tracy M, Wei C, Sever S, Smoyer W, Reiser J. Association of Serum Soluble Urokinase Receptor Levels With Progression of Kidney Disease in Children. JAMA Pediatr 2017; 171:e172914. [PMID: 28873129 PMCID: PMC6121753 DOI: 10.1001/jamapediatrics.2017.2914] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Conventional methods to diagnose and monitor chronic kidney disease (CKD) in children, such as creatinine level and cystatin C-derived estimated glomerular filtration rate (eGFR) and assessment of proteinuria in spot or timed urine samples, are of limited value in identifying patients at risk of progressive kidney function loss. Serum soluble urokinase receptor (suPAR) levels strongly predict incident CKD stage 3 in adults. Objective To determine whether elevated suPAR levels are associated with renal disease progression in children with CKD. Design, Setting, and Participants Post hoc analysis of 2 prospectively followed up pediatric CKD cohorts, ie, the ESCAPE Trial (1999-2007) and the 4C Study (2010-2016), with serum suPAR level measured at enrollment and longitudinal eGFR measured prospectively. In the 2 trials, a total of 898 children were observed at 30 (ESCAPE Trial; n = 256) and 55 (4C Study; n = 642) tertiary care hospitals in 13 European countries. Renal diagnoses included congenital anomalies of the kidneys and urinary tract (n = 637 [70.9%]), tubulointerstitial nephropathies (n = 92 [10.2%]), glomerulopathies (n = 69 [7.7%]), postischemic CKD (n = 42 [4.7%]), and other CKD (n = 58 [6.5%]). Total follow-up duration was up to 7.9 years, and median follow-up was 3.1 years. Analyses were conducted from October 2016 to December 2016. Exposures Serum suPAR level was measured at enrollment, and eGFR was measured every 2 months in the ESCAPE Trial and every 6 months in the 4C Study. The primary end point of CKD progression was a composite of 50% eGFR loss, eGFR less than 10 mL/min/1.73 m2, or initiation of renal replacement therapy. Main Outcomes and Measures The primary end point in this study was renal survival, defined as a composite of 50% loss of GFR that persisted for at least 1 month, the start of renal replacement therapy, or an eGFR less than 10 mL/min/1.73 m2. Results Of the 898 included children, 560 (62.4%) were male, and the mean (SD) patient age at enrollment was 11.9 (3.5) years. The mean (SD) eGFR was 34 (16) mL/min/1.73 m2. The 5-year end point-free renal survival was 64.5% (95% CI, 57.4-71.7) in children with suPAR levels in the lowest quartile compared with 35.9% (95% CI, 28.7-43.0) in those in the highest quartile (P < .001). By multivariable analysis, the risk of attaining the end point was higher in children with glomerulopathies and increased with age, blood pressure, proteinuria, and lower eGFR at baseline. In patients with baseline eGFR greater than 40 mL/min/1.73 m2, higher log-transformed suPAR levels were associated with a higher risk of CKD progression after adjustment for traditional risk factors (hazard ratio, 5.12; 95% CI, 1.56-16.7; P = .007). Conclusions and Relevance Patients with high suPAR levels were more likely to have progression of their kidney disease. Further studies should determine whether suPAR levels can identify children at risk for future CKD.
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Affiliation(s)
- Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Howard Trachtman
- Department of Pediatrics, Division of Nephrology, New York University Langone Medical Center, New York
| | - Elke Wühl
- Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Marietta Kirchner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Salim S Hayek
- Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Ali Anarat
- Department of Pediatric Nephrology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Ali Duzova
- Pediatric Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sevgi Mir
- Pediatric Nephrology, Ege University Faculty of Medicine, Izmir, Turkey
| | | | - Alev Yilmaz
- Department of Pediatric Nephrology, Istanbul Medical Faculty, Istanbul, Turkey
| | | | - Klaus Arbeiter
- Pediatric Nephrology, Vienna University Children's Hospital, Vienna, Austria
| | - Mieczyslaw Litwin
- Nephrology, Kidney Transplantation and Hypertension, Children's Memorial Health Institute, Warzaw, Poland
| | - Jun Oh
- Pediatric Nephrology, Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Chiara Matteucci
- Division of Pediatric Nephrology, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | - Jutta Gellermann
- Pediatric Nephrology, Charité Children's Hospital, Berlin, Germany
| | - Simone Wygoda
- Children's Dialysis Center, Hospital St Georg, Leipzig, Germany
| | | | - Günter Klaus
- KfH Kidney Center for Children, Marburg, Germany
| | - Jiri Dusek
- Pediatrics, University Hospital Motol, Prague, Czech Republic
| | - Sara Testa
- Pediatric Nephrology and Dialysis, Fondazione OSP Maggiore Policlinico, Milano, Italy
| | - Aleksandra Zurowska
- Department of Pediatric and Adolescent Nephrology, Medical University Gdańsk, Gdańsk, Poland
| | | | - Melissa Tracy
- Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Changli Wei
- Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Sanja Sever
- Harvard Medical School and Division of Nephrology, Massachusetts General Hospital, Charlestown
| | - William Smoyer
- The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus
| | - Jochen Reiser
- Department of Medicine, Rush University Medical Center, Chicago, Illinois
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