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Gavriilaki E, Bousiou Z, Batsis I, Vardi A, Mallouri D, Koravou EE, Konstantinidou G, Spyridis N, Karavalakis G, Noli F, Patriarcheas V, Masmanidou M, Touloumenidou T, Papalexandri A, Poziopoulos C, Yannaki E, Sakellari I, Politou M, Papassotiriou I. Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR) and Growth Differentiation Factor-15 (GDF-15) Levels Are Significantly Associated with Endothelial Injury Indices in Adult Allogeneic Hematopoietic Cell Transplantation Recipients. Int J Mol Sci 2023; 25:231. [PMID: 38203404 PMCID: PMC10778584 DOI: 10.3390/ijms25010231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Hematopoietic stem cell transplantation-associated thrombotic microangiopathy (HSCT-TMA) and graft-versus-host disease (GvHD) represent life-threatening syndromes after allogeneic hematopoietic stem cell transplantation (allo-HSCT). In both conditions, endothelial dysfunction is a common denominator, and development of relevant biomarkers is of high importance for both diagnosis and prognosis. Despite the fact that soluble urokinase plasminogen activator receptor (suPAR) and growth differentiation factor-15 (GDF-15) have been determined as endothelial injury indices in various clinical settings, their role in HSCT-related complications remains unexplored. In this context, we used immunoenzymatic methods to measure suPAR and GDF-15 levels in HSCT-TMA, acute and/or chronic GVHD, control HSCT recipients, and apparently healthy individuals of similar age and gender. We found considerably greater SuPAR and GDF-15 levels in HSCT-TMA and GVHD patients compared to allo-HSCT and healthy patients. Both GDF-15 and suPAR concentrations were linked to EASIX at day 100 and last follow-up. SuPAR was associated with creatinine and platelets at day 100 and last follow-up, while GDF-15 was associated only with platelets, suggesting that laboratory values do not drive EASIX. SuPAR, but not GDF-15, was related to soluble C5b-9 levels, a sign of increased HSCT-TMA risk. Our study shows for the first time that suPAR and GDF-15 indicate endothelial damage in allo-HSCT recipients. Rigorous validation of these biomarkers in many cohorts may provide utility for their usefulness in identifying and stratifying allo-HSCT recipients with endothelial cell impairment.
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Affiliation(s)
- Eleni Gavriilaki
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Zoi Bousiou
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Ioannis Batsis
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Anna Vardi
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Despina Mallouri
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Evaggelia-Evdoxia Koravou
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Georgia Konstantinidou
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Nikolaos Spyridis
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Georgios Karavalakis
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Foteini Noli
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Vasileios Patriarcheas
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Marianna Masmanidou
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Tasoula Touloumenidou
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Apostolia Papalexandri
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Christos Poziopoulos
- Department of Hematology, Metropolitan Hospital, Neo Faliro, 18547 Athens, Greece;
| | - Evangelia Yannaki
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Ioanna Sakellari
- BMT Unit, Hematology Department, George Papanicolaou General Hospital, 57010 Thessaloniki, Greece; (Z.B.); (I.B.); (A.V.); (D.M.); (E.-E.K.); (G.K.); (N.S.); (G.K.); (F.N.); (V.P.); (M.M.); (T.T.); (A.P.); (E.Y.); (I.S.)
| | - Marianna Politou
- Hematology Laboratory-Blood Bank, Aretaieion Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Ioannis Papassotiriou
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece;
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Huang DT, Ramirez P. Biomarkers in the ICU: less is more? Yes. Intensive Care Med 2020; 47:94-96. [PMID: 32347324 DOI: 10.1007/s00134-020-06049-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/09/2020] [Indexed: 01/11/2023]
Affiliation(s)
- David T Huang
- CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, University of Pittsburgh, Pittsburgh, PA, USA. .,MACRO (Multidisciplinary Acute Care Research Organization) Center, University of Pittsburgh, Pittsburgh, PA, USA. .,Department of Critical Care Medicine, University of Pittsburgh, 606B Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA. .,Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Paula Ramirez
- Department of Critical Care Medicine, Hospital Universitario Y Politécnico La Fe, Av Fernando Abril Martorell 106, 46026, Valencia, Spain. .,Centro de Investigación Biomédica en Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), Carlos III Research Institute, Madrid, Spain.
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Ebbesen MS, Kissow H, Hartmann B, Grell K, Gørløv JS, Kielsen K, Holst JJ, Müller K. Glucagon-Like Peptide-1 Is a Marker of Systemic Inflammation in Patients Treated with High-Dose Chemotherapy and Autologous Stem Cell Transplantation. Biol Blood Marrow Transplant 2019; 25:1085-1091. [PMID: 30731250 DOI: 10.1016/j.bbmt.2019.01.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/31/2019] [Indexed: 12/12/2022]
Abstract
Autologous stem cell transplantation (ASCT) is challenged by side effects that may be propagated by chemotherapy-induced mucositis, resulting in bacterial translocation and systemic inflammation. Because gastrointestinal damage appears as an early event in this cascade of reactions, we hypothesized that markers reflecting damage to the intestinal barrier could serve as early predictive markers of toxicity. Glucagon-like peptide-1 (GLP-1), a well-known regulator of blood glucose, has been found to promote intestinal growth and repair in animal studies. We investigated fasting GLP-1 plasma levels in 66 adults undergoing ASCT for lymphoma and multiple myeloma. GLP-1 increased significantly after chemotherapy, reaching peak levels at day +7 post-transplant (median, 8 pmol/L [interquartile range, 4 to 12] before conditioning versus 10 pmol/L [interquartile range, 6 to 17] at day +7; P = .007). The magnitude of the GLP-1 increase was related to the intensity of conditioning. GLP-1 at the day of transplantation (day 0) was positively associated with peak C-reactive protein (CRP) levels (46 mg/L per GLP-1 doubling, P < .001) and increase in days with fever (32% per GLP-1 doubling, P = .0058). Patients with GLP-1 above the median at day 0 had higher CRP levels from days +3 to +10 post-transplant than patients with lower GLP-1 (P ≤ .041) with peak values of 238 versus 129 mg/L, respectively. This study, which represents the first clinical investigation of fasting GLP-1 in relation to high-dose chemotherapy, provides evidence that GLP-1 plays a role in regulation of mucosal defenses. Fasting GLP-1 levels may serve as an early predictor of systemic inflammation and fever in patients receiving high-dose chemotherapy.
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Affiliation(s)
- Maria Schou Ebbesen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark.
| | - Hannelouise Kissow
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Bolette Hartmann
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Kathrine Grell
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark; Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Katrine Kielsen
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark; Institute for Inflammation Research, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Jens Juul Holst
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; NNF Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Müller
- Department of Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark; Institute for Inflammation Research, University Hospital Rigshospitalet, Copenhagen, Denmark
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Selleri C, Montuori N, Salvati A, Serio B, Pesapane A, Ricci P, Gorrasi A, Li Santi A, Hoyer-Hansen G, Ragno P. Involvement of urokinase receptor in the cross-talk between human hematopoietic stem cells and bone marrow microenvironment. Oncotarget 2018; 7:60206-60217. [PMID: 27517491 PMCID: PMC5312379 DOI: 10.18632/oncotarget.11115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 07/18/2016] [Indexed: 02/02/2023] Open
Abstract
Hematopoietic stem cells (HSCs) reside in bone marrow (BM) and can be induced to mobilize into the circulation for transplantation. Homing and lodgement into BM of transplanted HSCs are the first critical steps in their engraftment and involve multiple interactions between HSCs and the BM microenvironment.uPAR is a three domain receptor (DIDIIDIII) which binds urokinase, vitronectin, integrins. uPAR can be cleaved and shed from the cell surface generating full-length and cleaved soluble forms (suPAR and DIIDIII-suPAR). DIIDIII-suPAR can bind fMLF receptors through the SRSRY sequence (residues 88-92).We previously reported the involvement of soluble uPAR in HSC mobilization. We now investigate its possible role in HSC homing and engraftment.We show similar levels of circulating full-length suPAR in healthy donors and in acute myeloid leukemia (AML) patients before and after the pre-transplant conditioning regimen. By contrast, levels of circulating DIIDIII-suPAR in AML patients are higher as compared to controls and significantly decrease after the conditioning.We found that suPAR and uPAR84-95, a uPAR-derived peptide which mimics active DIIDIII-suPAR, induce a significant increase in Long Term Culture (LTC)-Initiating Cells (ICs) and in the release of clonogenic progenitors from LTCs of CD34+ HSCs. Further, suPAR increases adhesion and survival of CD34+ KG1 AML cells, whereas uPAR84-95 increases their proliferation.Thus, circulating DIIDIII-suPAR, strongly increased in HSC mobilization, is indeed down-regulated by pre-transplant conditioning, probably to favour HSC homing. BM full-length suPAR and DIIDIII-suPAR may be involved in HSC lodgement within the BM by contributing to a suitable microenvironment.
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Affiliation(s)
- Carmine Selleri
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Nunzia Montuori
- Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
| | - Annamaria Salvati
- Department of Chemistry and Biology, University of Salerno, Salerno, Italy
| | - Bianca Serio
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Ada Pesapane
- Department of Translational Medical Sciences, "Federico II" University, Naples, Italy
| | - Patrizia Ricci
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Anna Gorrasi
- Department of Chemistry and Biology, University of Salerno, Salerno, Italy
| | - Anna Li Santi
- Department of Chemistry and Biology, University of Salerno, Salerno, Italy
| | | | - Pia Ragno
- Department of Chemistry and Biology, University of Salerno, Salerno, Italy
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Pu YD, Deng Q, Cui R, Yuan T, Zhang R, Qi Y, Ma L, Li YM. [The clinical value of soluble urokinase plasminogen activation receptor in febrile neutropenic patients with hematological malignancies after chemotherapy]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2017; 38:1066-1068. [PMID: 29365403 PMCID: PMC7342195 DOI: 10.3760/cma.j.issn.0253-2727.2017.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Indexed: 11/05/2022]
Affiliation(s)
| | - Q Deng
- Department of Hematology, Tianjin First Center Hospital, Tianjin 300192, China
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Pontoppidan PL, Jordan K, Carlsen AL, Uhlving HH, Kielsen K, Christensen M, Ifversen M, Nielsen CH, Sangild P, Heegaard NHH, Heilmann C, Sengeløv H, Müller K. Associations between gastrointestinal toxicity, micro RNA and cytokine production in patients undergoing myeloablative allogeneic stem cell transplantation. Int Immunopharmacol 2015; 25:180-8. [PMID: 25614225 DOI: 10.1016/j.intimp.2014.12.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 11/28/2014] [Accepted: 12/30/2014] [Indexed: 11/25/2022]
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is a procedure with a high risk of treatment related mortality. The primary aim of the present study was to examine associations between markers of gastrointestinal toxicity, markers of systemic inflammation, and plasma levels of microRNA (miRNA) -155 and -146a during the first month after HSCT. The secondary aim was to characterize the impact of the toxic-inflammatory response on the function of circulating leukocytes during immune recovery. Thirty HSCT patients were included. Gastrointestinal injury was monitored by toxicity scores, lactulose-mannitol test and plasma citrulline, as a measure of the enterocyte population. Nadir of citrulline and maximum of oral toxicity scores, intestinal permeability, CRP and plasma levels of IL-6 and IL-10 was seen at day +7 post-HSCT. miRNA-155 and mi-RNA-146a showed an inverse relation with significantly elevated miRNA-155 and decreased miRNA-146a levels, from day 0 to day +28 compared with pre-conditioning levels. Citrulline levels below the median at day +7 were associated with higher spontaneous production of IL-6 and TNF-α as well as higher in vitro stimulated production of IL-17A at day +21. This study is the first to demonstrate that toxic responses to chemotherapy are accompanied by differential regulation of miRNAs with opposing effects on immune regulation. We find that a proinflammatory miRNA profile is sustained during the first three weeks after the transplantation, indicating that these miRNAs may play a role in the regulation of the inflammatory environment during immune reconstitution after HSCT.
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Affiliation(s)
- Peter L Pontoppidan
- Rigshospitalet, Copenhagen, Denmark; Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
| | - Karina Jordan
- Rigshospitalet, Copenhagen, Denmark; Institute for Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen, Denmark
| | - Anting Liu Carlsen
- Department of Clinical Biochemistry, Immunology and Genetics, Statens Serum Institut, Denmark
| | - Hilde Hylland Uhlving
- Rigshospitalet, Copenhagen, Denmark; Institute for Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen, Denmark
| | - Katrine Kielsen
- Rigshospitalet, Copenhagen, Denmark; Institute for Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen, Denmark
| | - Mette Christensen
- Department of Clinical Genetics, Rigshospitalet, Copenhagen, Denmark
| | | | - Claus Henrik Nielsen
- Institute for Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen, Denmark
| | - Per Sangild
- Rigshospitalet, Copenhagen, Denmark; Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Niels Henrik Helweg Heegaard
- Department of Clinical Biochemistry, Immunology and Genetics, Statens Serum Institut, Denmark; Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Denmark
| | | | | | - Klaus Müller
- Rigshospitalet, Copenhagen, Denmark; Institute for Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen, Denmark
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Jordan KKI, Christensen IJ, Heilmann C, Sengeløv H, Müller KG. Pretransplant C-reactive Protein as A Prognostic Marker in Allogeneic Stem Cell Transplantation. Scand J Immunol 2014; 79:206-13. [DOI: 10.1111/sji.12137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 11/25/2013] [Indexed: 01/30/2023]
Affiliation(s)
- K. K. I. Jordan
- Department of Pediatric and Adolescent Medicine 4072 and Institute for Inflammation Research 7541; National University Hospital; Rigshospitalet; Copenhagen Denmark
| | - I. J. Christensen
- The Finsen Laboratory; Rigshospitalet and Biotech Research and Innovation Center (BRIC); University of Copenhagen; Copenhagen Denmark
| | - C. Heilmann
- Department of Pediatric and Adolescent Medicine 4072 and Institute for Inflammation Research 7541; National University Hospital; Rigshospitalet; Copenhagen Denmark
| | - H. Sengeløv
- Department of Haematology 4042; National University Hospital; Rigshospitalet; Copenhagen Denmark
| | - K. G. Müller
- Department of Pediatric and Adolescent Medicine 4072 and Institute for Inflammation Research 7541; National University Hospital; Rigshospitalet; Copenhagen Denmark
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The significance of serum urokinase plasminogen activation receptor (suPAR) in the diagnosis and follow-up of febrile neutropenic patients with hematologic malignancies. Int J Infect Dis 2013; 17:e1056-9. [PMID: 23742830 DOI: 10.1016/j.ijid.2013.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 04/12/2013] [Accepted: 04/16/2013] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The purpose of this study was to investigate serum levels of serum urokinase plasminogen activation receptor (suPAR) during the first week of febrile neutropenia and to demonstrate the significance of this biomarker in the diagnosis and follow-up of febrile neutropenic patients with hematologic malignancies. METHODS The study was performed between January 2011 and January 2012 at Karadeniz Technical University, Turkey. For neutropenic patients with hematologic malignancies, the day before the onset of fever and the first day of the febrile neutropenia attack were taken as days 0 and 1, respectively. Blood samples were obtained from patients with hematologic malignancies on days 0, 1, 3, 5, and 7. Sixty-eight healthy volunteers were enrolled as the control group. suPAR levels were determined using an ELISA kit following the manufacturer's protocols. Twenty-six male and 14 female patients with hematologic malignancies, the majority with acute/myeloid/lymphocytic leukemia, aged 19-78 years (mean 46.8 years), were included. Fifty febrile neutropenic attacks were investigated in these patients. RESULTS The mean serum levels of the controls and suPAR 0 were 3.9 ± 1.5 ng/ml and 5.8 ± 2.7 ng/ml, respectively. Serum levels of suPAR rose earlier than levels of C-reactive protein and procalcitonin. Serum suPAR levels increased in patients with hematologic malignancies and were found to represent an important serum biomarker for the early prediction of neutropenic fever. A decrease in serum suPAR levels was found to be correlated with treatment response due to antibiotics in this patient group. There were significant differences in suPAR 1 levels between patients with documented infection and those with fever of unknown origin in favor of the former. When the suPAR 1 results were analyzed using the receiver operating characteristics (ROC) curve method, the optimum diagnostic cut-off point was 5.87 ng/ml, the area underneath the ROC curve (AUC) was 0.81 (95% confidence interval 0.68-0.91), sensitivity was 100%, specificity was 69%, negative predictive value (NPV) was 100%, and positive predictive value (PPV) was 70%. CONCLUSIONS We conclude that suPAR is an important biomarker that can predict infections in the early stage of febrile neutropenia with high sensitivity and NPV for patients with hematologic malignancies. It is also advantageous since it shows the response to treatment with antibiotherapy in the early stage.
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