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Khalaji A, Babajani N, Amirsardari Z, Saeedian B, Peiman S, Berger NA, Behnoush AH. Unveiling the Ghrelin and Obestatin Roles in Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis Assessing Their Pathogenic Implications and Biomarker Utility. Inflamm Bowel Dis 2024; 30:629-640. [PMID: 37669127 DOI: 10.1093/ibd/izad202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD), pathologically known as chronic inflammation of the gastrointestinal tract, is among the diseases with a high burden worldwide. Ghrelin and obestatin, as adipocytokines mainly in adipose tissues, are involved in immune responses and inflammatory pathways. Studies have assessed the circulatory ghrelin levels in patients with IBD. Herein, we aim to pool these studies through systematic review and meta-analysis. METHODS Four international databases, PubMed, Embase, Scopus, and the Web of Science were systematically searched for studies assessing ghrelin or obestatin levels in patients with IBD (either Crohn's disease [CD] or ulcerative colitis [UC]) in active phase or in remission. Random-effects meta-analysis was conducted in order to calculate the pooled estimate using the standardized mean difference (SMD) and 95% confidence interval (CI). RESULTS Nineteen studies were included in our systematic review, comprising 1064 patients with IBD (476 UC and 588 CD). A meta-analysis of 11 studies for comparison of active and quiescent disease showed that patients with active IBD had significantly higher levels of ghrelin (SMD, 0.70; 95% CI, 0.06 to 1.34; P = .03). However, in separate analyses for UC or CD, no such difference was observed (SMD, 1.30; 95% CI, -0.28 to 2.88, P = .11; and SMD, 0.80; 95% CI, -0.41 to 2.01; P = .20, respectively). No significant difference was also observed in ghrelin levels between patients with active IBD and healthy control subjects. Obestatin levels also were not different between patients with active disease and those in remission (SMD, 0.31; 95% CI, -0.05 to 0.68; P = .09). On the other hand, the obestatin/ghrelin ratio was significantly lower in patients with active IBD (SMD, -1.90; 95% CI, -2.45 to -1.35; P < .01). CONCLUSIONS Our results demonstrate that IBD patients with active disease have higher levels of ghrelin, which needs to be confirmed in future studies. Also, the obestatin/ghrelin ratio might be a promising biomarker for the assessment of disease activity.
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Affiliation(s)
| | - Nastaran Babajani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Amirsardari
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Behrad Saeedian
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Peiman
- Department of Internal Medicine, AdventHealth Orlando Hospital, Orlando, FL, USA
| | - Nathan A Berger
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
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Erbak Yılmaz H, Aksun S, Günay S, Elmalı F, Çekiç C. Evaluation of plasma soluble urokinase plasminogen activator receptor (SuPAR) levels in ulcerative colitis. Arab J Gastroenterol 2023; 24:175-179. [PMID: 37045728 DOI: 10.1016/j.ajg.2023.03.001] [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: 03/14/2022] [Revised: 02/13/2023] [Accepted: 03/17/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND AND STUDY AIM Soluble urokinase plasminogen activator receptor (SuPAR), a soluble form of the urokinase-type plasminogen activator receptor, is a biomarker produced by macrophages, monocytes, neutrophils, active T cells, endothelial cells, and circulating tumor cells. SuPAR is a novel biomarker showing altered inflammation in many inflammatory diseases. This study aims to investigate the SuPAR level in ulcerative colitis (UC) patients, and to evaluate the SuPAR level in active, and remission patients. PATIENTS AND METHODS Patient and healthy control SuPAR levels were analyzed by immunoassay method. SuPAR levels between UC patients and control group were compared. The difference between SuPAR levels in patients with active UC and UC in remission was analyzed. The relationship between C-reactive protein level, Total Mayo score, Mayo Endoscopic score used to predict disease activity, and amount of SuPAR were evaluated. RESULTS SuPAR levels were determined in the UC patient group (2170,3 ± 121,0 pg/ml), and healthy controls (2130,7 ± 164,8 pg/ml) (p = 0. 805). Median SuPAR levels were determined in moderate UC (2479 pg/ml), mild UC (1944 pg/ml), and patients in remission (1774 pg/ml) (p = 0,207). There were no significant relationships between SuPAR levels and CRP levels, Total Mayo score, disease duration in the UC group (r = 0.177, r = 0.267, and r = 0,007; respectively p > 0.05). A slightly positive correlation was found between Mayo Endoscopic Score and SuPAR level (r = 0.303; p = 0.031). CONCLUSION SuPAR is of limited value in the diagnosis of ulcerative colitis and in the assessment of disease activation.
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Affiliation(s)
- Huriye Erbak Yılmaz
- Izmir Katip Çelebi University Atatürk Training and Research Hospital, Biochemistry Laboratory Izmir, Turkey; Izmir Biomedicine and Genom Center, Izmir, Turkey.
| | - Saliha Aksun
- Izmir Katip Çelebi University, Department of Biochemistry, Izmir, Turkey
| | - Süleyman Günay
- Izmir Katip Çelebi University, Department of Gastroenterology, Izmir, Turkey
| | - Ferhan Elmalı
- Izmir Katip Çelebi University, Department of Biostatistics, Izmir, Turkey
| | - Cem Çekiç
- Izmir Tinaztepe University, Department of Gastroenterology, Izmir, Turkey
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3
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Tsangaris I, Antonakos N, Fantoni M, Kaplanski G, Kyriazopoulou E, Veas F, Clemens M. BIOMARKERS: CAN THEY REALLY GUIDE OUR DAILY PRACTICE? Shock 2023; 59:16-20. [PMID: 36867757 DOI: 10.1097/shk.0000000000001957] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
ABSTRACT Optimal management of septic patients requires accurate assessment of both current severity status and prognosis. Since the 1990s, substantial advances have been made in the use of circulating biomarkers for such assessments. This summary of the session on "Biomarkers: can they really use guide our daily practice?" presented at the 2021 WEB-CONFERENCE OF THE EUROPEAN SHOCK SOCIETY, 6 November 2021. These biomarkers include ultrasensitive detection of bacteremia, circulating soluble urokina-type plasminogen activator receptor (suPAR), C-reactive protein (CRP) and ferritin and procalcitonin. In addition, the potential application of novel multiwavelength optical biosensor technology allows noninvasive monitoring of multiple metabolites that can be used to assess severity and prognosis in septic patients. The application these biomarkers and improved technologies provide the potential for improved personalized management of septic patients.
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Affiliation(s)
- Iraklis Tsangaris
- 2nd Department of Critical Care Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Antonakos
- 4th Department of Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Gilles Kaplanski
- Division of Internal Medicine and Clinical Immunology, Hôpital de la Conception, C2VN-INSERM U1263, Aix-Marseille University, Marseille, France
| | - Evdoxia Kyriazopoulou
- 2nd Department of Critical Care Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Mark Clemens
- Department of Biological Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
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Özdirik B, Maibier M, Scherf M, Nicklaus JM, Frohme J, Puengel T, Meyer zum Büschenfelde D, Tacke F, Mueller T, Sigal M. Soluble Urokinase Plasminogen Activator Receptor Levels Are Associated with Severity of Fibrosis in Patients with Primary Sclerosing Cholangitis. J Clin Med 2022; 11:jcm11092479. [PMID: 35566603 PMCID: PMC9105770 DOI: 10.3390/jcm11092479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 04/23/2022] [Accepted: 04/26/2022] [Indexed: 12/07/2022] Open
Abstract
The soluble urokinase-type plasminogen activator receptor (suPAR) has evolved as a useful biomarker for different entities of chronic liver disease. However, its role in patients with primary sclerosing cholangitis (PSC) is obscure. We analyzed plasma levels of suPAR in 84 patients with PSC and compared them to 68 patients with inflammatory bowel disease (IBD) without PSC and to 40 healthy controls. Results are correlated with clinical records. suPAR concentrations were elevated in patients with PSC compared to patients with IBD only and to healthy controls (p < 0.001). Elevated suPAR levels were associated with the presence of liver cirrhosis (p < 0.001) and signs of portal hypertension (p < 0.001). suPAR revealed a high accuracy for the discrimination of the presence of liver cirrhosis comparable to previously validated noninvasive fibrosis markers (area under the curve (AUC) 0.802 (95%CI: 0.702−0.902)). Further, we demonstrated that suPAR levels may indicate the presence of acute cholangitis episodes (p < 0.001). Finally, despite the high proportion of PSC patients with IBD, presence of IBD and its disease activity did not influence circulating suPAR levels. suPAR represents a previously unrecognized biomarker for diagnosis and liver cirrhosis detection in patients with PSC. However, it does not appear to be confounded by intestinal inflammation in the context of IBD.
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Affiliation(s)
- Burcin Özdirik
- Department of Hepatology and Gastroenterology, Campus Virchow Klinikum (CVK) and Campus Charité Mitte (CCM), Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (M.M.); (M.S.); (J.M.N.); (J.F.); (T.P.); (F.T.); (T.M.); (M.S.)
- Berlin Institute of Health, 10178 Berlin, Germany
- Correspondence: ; Tel.: +49-30-450-656-004; Fax: +49-30-450-553-902
| | - Martin Maibier
- Department of Hepatology and Gastroenterology, Campus Virchow Klinikum (CVK) and Campus Charité Mitte (CCM), Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (M.M.); (M.S.); (J.M.N.); (J.F.); (T.P.); (F.T.); (T.M.); (M.S.)
| | - Maria Scherf
- Department of Hepatology and Gastroenterology, Campus Virchow Klinikum (CVK) and Campus Charité Mitte (CCM), Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (M.M.); (M.S.); (J.M.N.); (J.F.); (T.P.); (F.T.); (T.M.); (M.S.)
| | - Jule Marie Nicklaus
- Department of Hepatology and Gastroenterology, Campus Virchow Klinikum (CVK) and Campus Charité Mitte (CCM), Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (M.M.); (M.S.); (J.M.N.); (J.F.); (T.P.); (F.T.); (T.M.); (M.S.)
| | - Josephine Frohme
- Department of Hepatology and Gastroenterology, Campus Virchow Klinikum (CVK) and Campus Charité Mitte (CCM), Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (M.M.); (M.S.); (J.M.N.); (J.F.); (T.P.); (F.T.); (T.M.); (M.S.)
| | - Tobias Puengel
- Department of Hepatology and Gastroenterology, Campus Virchow Klinikum (CVK) and Campus Charité Mitte (CCM), Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (M.M.); (M.S.); (J.M.N.); (J.F.); (T.P.); (F.T.); (T.M.); (M.S.)
- Berlin Institute of Health, 10178 Berlin, Germany
| | - Dirk Meyer zum Büschenfelde
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, 13353 Berlin, Germany;
- Labor Berlin—Charité Vivantes GmbH, 13353 Berlin, Germany
| | - Frank Tacke
- Department of Hepatology and Gastroenterology, Campus Virchow Klinikum (CVK) and Campus Charité Mitte (CCM), Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (M.M.); (M.S.); (J.M.N.); (J.F.); (T.P.); (F.T.); (T.M.); (M.S.)
| | - Tobias Mueller
- Department of Hepatology and Gastroenterology, Campus Virchow Klinikum (CVK) and Campus Charité Mitte (CCM), Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (M.M.); (M.S.); (J.M.N.); (J.F.); (T.P.); (F.T.); (T.M.); (M.S.)
| | - Michael Sigal
- Department of Hepatology and Gastroenterology, Campus Virchow Klinikum (CVK) and Campus Charité Mitte (CCM), Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; (M.M.); (M.S.); (J.M.N.); (J.F.); (T.P.); (F.T.); (T.M.); (M.S.)
- Berlin Institute for Medical Systems Biology (BIMSB), Max Delbrück Center for Molecular Medicine, 10115 Berlin, Germany
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Knyazev E, Maltseva D, Raygorodskaya M, Shkurnikov M. HIF-Dependent NFATC1 Activation Upregulates ITGA5 and PLAUR in Intestinal Epithelium in Inflammatory Bowel Disease. Front Genet 2021; 12:791640. [PMID: 34858489 PMCID: PMC8632048 DOI: 10.3389/fgene.2021.791640] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022] Open
Abstract
Intestinal epithelial cells exist in physiological hypoxia, leading to hypoxia-inducible factor (HIF) activation and supporting barrier function and cell metabolism of the intestinal epithelium. In contrast, pathological hypoxia is a common feature of some chronic disorders, including inflammatory bowel disease (IBD). This work was aimed at studying HIF-associated changes in the intestinal epithelium in IBD. In the first step, a list of genes responding to chemical activation of hypoxia was obtained in an in vitro intestinal cell model with RNA sequencing. Cobalt (II) chloride and oxyquinoline treatment of both undifferentiated and differentiated Caco-2 cells activate the HIF-signaling pathway according to gene set enrichment analysis. The core gene set responding to chemical hypoxia stimulation in the intestinal model included 115 upregulated and 69 downregulated genes. Of this set, protein product was detected for 32 genes, and fold changes in proteome and RNA sequencing significantly correlate. Analysis of publicly available RNA sequencing set of the intestinal epithelial cells of patients with IBD confirmed HIF-1 signaling pathway activation in sigmoid colon of patients with ulcerative colitis and terminal ileum of patients with Crohn's disease. Of the core gene set from the gut hypoxia model, expression activation of ITGA5 and PLAUR genes encoding integrin α5 and urokinase-type plasminogen activator receptor (uPAR) was detected in IBD specimens. The interaction of these molecules can activate cell migration and regenerative processes in the epithelium. Transcription factor analysis with the previously developed miRGTF tool revealed the possible role of HIF1A and NFATC1 in the regulation of ITGA5 and PLAUR gene expression. Detected genes can serve as markers of IBD progression and intestinal hypoxia.
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Affiliation(s)
- Evgeny Knyazev
- Laboratory of Microfluidic Technologies for Biomedicine, Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry of the Russian Academy of Sciences, Moscow, Russia
| | - Diana Maltseva
- Faculty of Biology and Biotechnology, National Research University Higher School of Economics (HSE), Moscow, Russia
| | - Maria Raygorodskaya
- Laboratory of Microfluidic Technologies for Biomedicine, Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry of the Russian Academy of Sciences, Moscow, Russia
| | - Maxim Shkurnikov
- Laboratory of Microfluidic Technologies for Biomedicine, Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry of the Russian Academy of Sciences, Moscow, Russia.,Faculty of Biology and Biotechnology, National Research University Higher School of Economics (HSE), Moscow, Russia.,National Center of Medical Radiological Research, P. Hertsen Moscow Oncology Research Institute, Moscow, Russia
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6
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Engström J, Lönnkvist M, Befrits R, Ljung T, Diaz-Tartera H, Holst M, Hellström PM. Comparison of fecal calprotectin and serum C-reactive protein in early prediction of outcome to infliximab induction therapy. Scand J Gastroenterol 2019; 54:1081-1088. [PMID: 31499013 DOI: 10.1080/00365521.2019.1660402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Fecal calprotectin (FC) and serum C-reactive protein (CRP) are biomarkers of disease activity in Crohn's disease (CD) and ulcerative colitis (UC). We assessed FC, CRP, Harvey-Bradshaw index (HBi), partial Mayo Clinic Scoring (pMCS) and a cytokine panel during infliximab induction to predict therapy outcome. Methods: FC, CRP and clinical indices were evaluated in 123 (76 CD, 47 UC) patients before infliximab induction and after 12 weeks. Responders were monitored 48 weeks for an 'incident' (dosage increase, shortened dosage interval, surgery). Cutoff values for FC and CRP were obtained using receiver-operating characteristics (ROC). Disease progression was analyzed with Kaplan-Meier survivals, log-rank test and logistic regression for combined biomarkers. Cytokines were analyzed with Luminex multiplexing system. Results: Following infliximab, FC and CRP declined (p < .0001) along with HBi for CD and pMCS for UC. Simultaneously, IL-6 and TNF-α decreased, while IL-10 increased. Optimal FC ROC cutoff was 221 µg/g (sensitivity 66%, specificity 67%, AUC 0.71) and CRP ROC cutoff 2.1 mg/L (sensitivity 54%, specificity 60%, AUC 0.58). In CD, FC > 221 µg/g (p < .0001), but not CRP > 2.1 mg/L predicted an 'incident'. However, combined FC and CRP also predicted an 'incident' (p < .042). In UC, both FC > 221 µg/g (p < .0005) and CRP > 2.1 mg/L (p = .0334) predicted 'incident', as did combined biomarkers (p < .005). Conclusions: Clinical disease activity is reduced by treatment with infliximab. In CD, persistently high FC, but not CRP, predict a treatment 'incident', whereas in UC both high FC and high CRP predict 'incident'. Combined FC and CRP values also predict an 'incident'.
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Affiliation(s)
- Johanna Engström
- Department of Medical Sciences, Gastroenterology and Hepatology, Uppsala University , Uppsala , Sweden
| | - Maria Lönnkvist
- Department of Medical Sciences, Gastroenterology and Hepatology, Uppsala University , Uppsala , Sweden
| | - Ragnar Befrits
- Department of Medicine, Gastroenterology and Hepatology, Karolinska University Hospital Solna, Karolinska Institutet , Stockholm , Sweden
| | - Tryggve Ljung
- Department of Medical Sciences, Gastroenterology and Hepatology, Uppsala University , Uppsala , Sweden
| | - Hetzel Diaz-Tartera
- Department of Medical Sciences, Gastroenterology and Hepatology, Uppsala University , Uppsala , Sweden
| | - Mikael Holst
- Department of Women's and Children's Health, Karolinska University Hospital Solna, Karolinska Institutet , Stockholm , Sweden
| | - Per M Hellström
- Department of Medical Sciences, Gastroenterology and Hepatology, Uppsala University , Uppsala , Sweden
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7
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Sorrentino D, Nguyen VQ, Chitnavis MV. Capturing the Biologic Onset of Inflammatory Bowel Diseases: Impact on Translational and Clinical Science. Cells 2019; 8:E548. [PMID: 31174359 PMCID: PMC6627618 DOI: 10.3390/cells8060548] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 12/16/2022] Open
Abstract
While much progress has been made in the last two decades in the treatment and the management of inflammatory bowel diseases (IBD)-both ulcerative colitis (UC) and Crohn's Disease (CD)-as of today these conditions are still diagnosed only after they have become symptomatic. This is a major drawback since by then the inflammatory process has often already caused considerable damage and the disease might have become partially or totally unresponsive to medical therapy. Late diagnosis in IBD is due to the lack of accurate, non-invasive indicators that would allow disease identification during the pre-clinical stage-as it is often done in many other medical conditions. Here, we will discuss what is known about the biologic onset and pre-clinical CD with an emphasis on studies conducted in patients' first degree relatives. We will then review the possible strategies to diagnose IBD very early in time including screening, available disease markers and imaging, and the possible clinical implications of treating these conditions at or close to their biologic onset. Later, we will review the potential impact of conducting translational research in IBD during the pre-clinical stage, especially focusing on the role of the microbiome in disease etiology and pathogenesis. Finally, we will highlight possible future developments in the field and how they can impact IBD management and our scientific knowledge of these conditions.
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Affiliation(s)
- Dario Sorrentino
- IBD Center, Division of Gastroenterology, Virginia Tech Carilion School of Medicine, FRACP 3 Riverside Circle, Roanoke, VA 24016, USA.
- Department of Clinical and Experimental Medical Sciences, University of Udine School of Medicine, 33100 Udine, Italy.
| | - Vu Q Nguyen
- IBD Center, Division of Gastroenterology, Virginia Tech Carilion School of Medicine, FRACP 3 Riverside Circle, Roanoke, VA 24016, USA.
| | - Maithili V Chitnavis
- IBD Center, Division of Gastroenterology, Virginia Tech Carilion School of Medicine, FRACP 3 Riverside Circle, Roanoke, VA 24016, USA.
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Hamie L, Daoud G, Nemer G, Nammour T, El Chediak A, Uthman IW, Kibbi AG, Eid A, Kurban M. SuPAR, an emerging biomarker in kidney and inflammatory diseases. Postgrad Med J 2018; 94:517-524. [PMID: 30177549 DOI: 10.1136/postgradmedj-2018-135839] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/10/2018] [Accepted: 07/28/2018] [Indexed: 12/12/2022]
Abstract
Soluble urokinase plasminogen activator receptor (suPAR) is a circulating form of a physiological and pathophysiological important cell surface receptor, implicated in inflammation. Recent studies showed that suPAR is a promising biomarker, useful for diagnosis, assessment and prognosis of several diseases. This review summarises the majority of preliminary studies and analyses the significance and the clinical application of suPAR in various clinical conditions. SuPAR seems to have a significant value in the diagnosis as well as prognosis of many diseases; nonetheless, it merits large-scale studies to set cut-off values that help physicians in following up their patients and accordingly tailor their treatment plans.
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Affiliation(s)
- Lamiaa Hamie
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Georges Daoud
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Georges Nemer
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Tarek Nammour
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alissar El Chediak
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Imad W Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Ghani Kibbi
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Assaad Eid
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mazen Kurban
- Department of Biochemistry and Molecular Genetics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon .,Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
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9
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Accuracy of Consecutive Fecal Calprotectin Measurements to Predict Relapse in Inflammatory Bowel Disease Patients Under Maintenance With Anti-TNF Therapy: A Prospective Longitudinal Cohort Study. J Clin Gastroenterol 2018; 52:229-234. [PMID: 27984399 DOI: 10.1097/mcg.0000000000000774] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND GOAL Predicting relapse in inflammatory bowel disease (IBD) patients could allow early changes in therapy. We aimed at evaluating the accuracy of consecutive fecal calprotectin (FC) measurements to predict flares in IBD patients under maintenance treatment with anti-tumor necrosis factor (TNF) drugs. STUDY A prospective longitudinal cohort study with 16-month follow-up period was designed. IBD patients in clinical remission for at least 6 months under anti-TNF therapy were included. FC was quantified at 4-month intervals for 1 year, and patients were clinically evaluated for relapse at 2-month intervals. Diagnostic accuracy of FC for predicting relapse was evaluated by receiver-operating characteristic curve analysis. RESULTS In total, 95 of 106 included patients finalized the study and were analyzed (median age 44 y, 50.5% female, 75% with Crohn's disease). A total of 30 patients (31.6%) had a relapse over follow-up. FC concentration was significantly higher in patients who relapsed (477 μg/g) than in patients who maintained in remission (65 μg/g) (P<0.005). The optimal cutoff to predict remission was 130 μg/g (negative predictive value of 100%), and 300 μg/g to predict relapse (positive predictive value of 78.3%). CONCLUSIONS FC is a good predictor of clinical relapse and a particularly good predictor of remission over the following 4 months in patients with IBD on maintenance therapy with anti-TNF drugs. FC levels <130 μg/g is consistently associated with maintained disease remission, whereas concentrations >300 μg/g allow predicting relapse with a high probability at any time over the following 4 months.
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Navas-López VM, Pujol Muncunill G, Llerena E, Navalón Rubio M, Gil-Ortega D, Varea-Calderón V, Sierra Salinas C, Martin-de-Carpi J. Efectividad y seguridad en nuestro entorno de adalimumab como tratamiento anti-TNF de primera linea en niños con enfermedad de Crohn. An Pediatr (Barc) 2018; 88:89-99. [DOI: 10.1016/j.anpedi.2017.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/03/2017] [Accepted: 01/09/2017] [Indexed: 10/19/2022] Open
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11
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A real-world study focused on the effectiveness and safety of adalimumab as first-line anti-TNF treatment for paediatric Crohn's disease. An Pediatr (Barc) 2018. [DOI: 10.1016/j.anpede.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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12
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Desmedt S, Desmedt V, Delanghe JR, Speeckaert R, Speeckaert MM. The intriguing role of soluble urokinase receptor in inflammatory diseases. Crit Rev Clin Lab Sci 2017; 54:117-133. [DOI: 10.1080/10408363.2016.1269310] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | | | - J. R. Delanghe
- Department of Clinical Chemistry, Ghent University Hospital, Gent, Belgium
| | - R. Speeckaert
- Department of Clinical Chemistry, Ghent University Hospital, Gent, Belgium
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Ferreiro-Iglesias R, Barreiro-de Acosta M, Lorenzo-Gonzalez A, Dominguez-Muñoz JE. Usefulness of a rapid faecal calprotectin test to predict relapse in Crohn's disease patients on maintenance treatment with adalimumab. Scand J Gastroenterol 2016; 51:442-7. [PMID: 26595391 DOI: 10.3109/00365521.2015.1115546] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM Predicting relapse in Crohn's disease (CD) patients by measuring non-invasive biomarkers could allow for early changes of treatment. Data are scarce regarding the utility of monitoring calprotectin to predict relapse. The aim of the study was to evaluate the predictive value of a rapid test of faecal calprotectin (FC) to predict for flares in CD patients on maintenance treatment with adalimumab (ADA). METHODS A prospective, observational cohort study was designed. Inclusion criteria were CD patients in clinical remission on a standard dose of ADA therapy. Fresh FC was measured using a rapid test. RESULTS Thirty patients were included (median age 38 years, 56.7% female). After the 4 months follow-up, 70.0% patients remained in clinical remission and 30.0% had a relapse. FC concentration at inclusion was significantly higher in those patients who relapsed during the follow-up (625 μg/g) compared to those who stayed in remission (45 μg/g). The optimal cut-off for FC to predict relapse was 204 μg/g. The area under the receiver-operating characteristic curve was 0.968. Sensitivity, specificity, positive, and negative predictive value of FC to predict relapse were 100%, 85.7%, 74.1%, and 100%, respectively. CONCLUSION In CD patients on ADA maintenance therapy, FC levels measured with a rapid test allow relapse over the following months to be predicted with high accuracy. Low FC levels exclude relapse within at least 4 months after testing, whereas high levels are associated with relapse in three out of every four patients.
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Affiliation(s)
- Rocio Ferreiro-Iglesias
- a Department of Gastroenterology and Hepatology , Hospital Clinico Universitario De Santiago De Compostela , Santiago de Compostela , Spain
| | - Manuel Barreiro-de Acosta
- a Department of Gastroenterology and Hepatology , Hospital Clinico Universitario De Santiago De Compostela , Santiago de Compostela , Spain
| | - Aurelio Lorenzo-Gonzalez
- a Department of Gastroenterology and Hepatology , Hospital Clinico Universitario De Santiago De Compostela , Santiago de Compostela , Spain
| | - Juan Enrique Dominguez-Muñoz
- a Department of Gastroenterology and Hepatology , Hospital Clinico Universitario De Santiago De Compostela , Santiago de Compostela , Spain
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Bamberger S, Martinez Vinson C, Mohamed D, Viala J, Carel JC, Hugot JP, Simon D. Growth and Adult Height in Patients with Crohn's Disease Treated with Anti-Tumor Necrosis Factor α Antibodies. PLoS One 2016; 11:e0163126. [PMID: 27636201 PMCID: PMC5026336 DOI: 10.1371/journal.pone.0163126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 09/03/2016] [Indexed: 12/19/2022] Open
Abstract
Inflammation contributes to growth failure associated with inflammatory bowel diseases. Anti-TNFα therapy induces sustained remission and short-term improvements in height velocity and/or height standard deviation score (H-SDS) patients with Crohn's disease. The purpose of this study was to evaluate growth and adult height in patients with Crohn's disease taking maintenance infliximab or adalimumab therapy.This university-hospital based retrospective study included 61 patients, with a median follow-up of 2.6 years (2.0; 3.3). 38 patients (62%) reached their adult height. H-SDS was collected at diagnosis and together with disease activity markers (Harvey-Bradshaw Index, albumin, and C-reactive protein) at treatment initiation (baseline), and follow-up completion. Wilcoxon's signed-rank test was chosen for comparisons. Median H-SDS decreased from diagnosis to baseline (-0.08 [-0.73; +0.77] to -0.94 [-1.44; +0.11], p<0.0001) and then increased to follow-up completion (-0.63 [-1.08; 0.49], p = 0.003 versus baseline), concomitantly with an improvement in disease activity. Median adult H-SDS was within the normal range (-0.72 [-1.25; +0.42]) but did not differ from baseline H-SDS and was significantly lower than the target H-SDS (-0.09 [-0.67; +0.42], p = 0.01). Only 2 (6%) males had adult heights significantly below their target heights (10.5 and -13.5 cm [-1.75 and -2.25 SD]). In conclusion, anti-tumor necrosis factor α (TNF) therapy prevented loss of height without fully restoring the genetic growth potential in this group of patients with CD. Earlier treatment initiation might improve growth outcomes in these patients.
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Affiliation(s)
- Sarah Bamberger
- Service de Gastroentérologie Pédiatrique, Assistance publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Christine Martinez Vinson
- Service de Gastroentérologie Pédiatrique, Assistance publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Damir Mohamed
- Unité d’Epidémiologie Clinique, Assistance publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Centre d’Investigation Clinique-Epidémiologie Clinique Unité 1426, Institut National de la Santé et de la Recherche Médicale (Inserm), Paris, France
| | - Jérôme Viala
- Service de Gastroentérologie Pédiatrique, Assistance publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Jean-Claude Carel
- Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Assistance publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Institut National de la Santé et de la Recherche Médicale (Inserm), Unité 1141, DHU Protect, Paris, France
| | - Jean-Pierre Hugot
- Service de Gastroentérologie Pédiatrique, Assistance publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Institut National de la Santé et de la Recherche Médicale (Inserm), Centre de Recherche sur l'Inflammation Unité 1149, Paris, France
| | - Dominique Simon
- Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Assistance publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
- Institut National de la Santé et de la Recherche Médicale (Inserm), Unité 1141, DHU Protect, Paris, France
- * E-mail:
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15
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Increased circulating soluble urokinase-type plasminogen activator receptor (suPAR) levels in patients with slow coronary flow. ACTA ACUST UNITED AC 2016; 1:e53-e59. [PMID: 28905020 PMCID: PMC5421532 DOI: 10.5114/amsad.2016.60819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/15/2016] [Indexed: 11/17/2022]
Abstract
Introduction Slow coronary flow (SCF) is an angiographic phenomenon characterized by delayed opacification of epicardial coronary arteries without an obstructive coronary disease. Serum soluble urokinase-type plasminogen activator receptor (suPAR) levels seem closely related to atherosclerosis due to increased inflammation and prothrombotic state. We studied whether circulating suPAR is related to SCF. Material and methods The present study was cross-sectional and observational. It included 75 individuals who underwent coronary angiography with suspected CAD and had angiographically normal coronary arteries of varying coronary flow rates. The relationship between suPAR, C-reactive protein (CRP) and SCF was investigated. Forty patients with isolated SCF (mean age: 46.0 ±4.14 years) and 35 age- and gender-matched control participants with normal coronary flow (NCF) and normal coronary arteries (NCA) (mean age: 46.0 ±5.7 years) were included in the study. We used logistic regression analysis to determine the predictors of SCF. Results The clinical characteristics were not statistically significantly different between SCF and NCA groups. Serum suPAR level was significantly higher in the SCF group than the control group (2.5–5.4 ng/ml vs. 0.1–1.4 ng/ml; p < 0.001). Also the serum CRP level was higher in the CSF group than the control group (1.57 ±0.43 mg/l vs. 0.53 ±0.23 mg/l; p < 0.001). Conclusions This study revealed significantly increased serum suPAR levels in patients with SCF. Although we cannot draw conclusions on the underlying pathological process of SCF, we believe that these findings may be pioneering for further studies investigating the specific roles of circulating suPAR in the SCF phenomenon in the coronary vasculature.
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16
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Miranda-García P, Chaparro M, Gisbert JP. Correlation between serological biomarkers and endoscopic activity in patients with inflammatory bowel disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 39:508-15. [PMID: 27020243 DOI: 10.1016/j.gastrohep.2016.01.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND/AIMS Endoscopy is the gold standard for assessing disease severity in inflammatory bowel disease (IBD), although it is an invasive procedure. Biological markers have been routinely used as a non-invasive means of determining disease activity. The aim of this study was to determine the correlation between common biological markers and endoscopic activity in IBD. METHODS Consecutive patients with IBD were included. Serum concentrations of different biomarkers (C-reactive protein [CRP], orosomucoid [ORM], erythrocyte sedimentation rate [ESR], fibrinogen, platelets, leukocytes, neutrophils and hemoglobin [Hb]) were measured, and their accuracy in detecting endoscopic activity was determined. RESULTS Eighty patients were included (mean age 46 years, 53% Crohn's disease), 70% with endoscopic activity. Among Crohn's disease patients, 24% had mild endoscopic activity, 12% moderate activity and 39% severe activity. Among ulcerative colitis patients, 35% had an endoscopic Mayo score of 0-1 points, 30% 2 points and 35% 3 points. None of the biomarkers included had a good correlation with endoscopic activity (Area Under the ROC curve [AUC]<0.70) in ulcerative colitis. ORM, fibrinogen and platelets had the best accuracy to detect endoscopic activity in Crohn's disease (AUC: 0.80-0.085). A sub-analysis in postoperative Crohn's disease patients found no correlation between endoscopic recurrence and biomarkers (AUC<0.70). CONCLUSION Serological biomarkers, including CRP, have low accuracy to detect endoscopic activity in ulcerative colitis and postoperative Crohn's disease. ORM, fibrinogen and platelets have the best accuracy to detect endoscopic activity in Crohn's disease.
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Affiliation(s)
| | - María Chaparro
- Gastroenterology Department, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) y Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Javier P Gisbert
- Gastroenterology Department, Hospital Universitario La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) y Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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17
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Abstract
Little is known on the natural history of Crohn's disease (CD) before diagnosis. By the time the patient is diagnosed, the disease has often produced considerable damage to the intestinal mucosa and sometimes other organs. Such period before diagnosis might involve both a silent and a symptomatic phase. The silent phase, or preclinical CD, might last several years after the biological disease onset. Evidence is accumulating that the symptomatic phase might also go undiagnosed for months or years. In fact, for each established case of CD, there are probably several undiagnosed cases, a classic iceberg phenomenon of disease. Such status quo--lagging behind diagnostic standards for many other diseases--effectively hampers efforts to block disease evolution and the development of complications. This is no longer tenable because CD is a debilitating, severe, and costly affection, whose incidence is rapidly rising worldwide. Here, we will review what is currently known on preclinical and undiagnosed CD and what could be done to improve accuracy and timeliness of diagnosis.
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18
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Fecal Calprotectin as Predictor of Relapse in Patients With Inflammatory Bowel Disease Under Maintenance Infliximab Therapy. J Clin Gastroenterol 2016; 50:147-51. [PMID: 25811118 DOI: 10.1097/mcg.0000000000000312] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND GOALS Predicting relapse in Inflammatory Bowel Disease (IBD) could allow for early changes of treatment. Close monitoring of fecal calprotectin (FC) could be useful to predict relapse in IBD. Aim of the study was to evaluate the predictive value of a rapid FC test to predict flares in patients with IBD under maintenance therapy with Infliximab. STUDY A prospective observational cohort study was designed. IBD patients in clinical remission under maintenance Infliximab therapy were included. FC was measured using a rapid test on a stool sample obtained within 24 hours before Infliximab infusion. Clinical examination was performed 2 months after that infusion. RESULTS Fifty-three patients were included (52.8% female). Thirty-three patients (62.3%) had Crohn's disease and 20 (37.7%) had ulcerative colitis. All patients were in remission at inclusion. After 2 months, 41 patients (77.4%) remained in clinical remission and 12 (22.6%) presented a relapse. FC (mean±SD) in relapsing and not-relapsing disease was 332±168 and 110±163 µg/g, respectively (P<0.005). A FC concentration>160 µg/g had a sensitivity of 91.7%, and specificity of 82.9% to predict relapse. CONCLUSIONS In IBD patients under Infliximab maintenance therapy, high FC levels allow predicting relapse within the following 2 months. Long-term remission is associated with low calprotectin levels. Further studies are required to confirm these results.
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Genua M, D'Alessio S, Cibella J, Gandelli A, Sala E, Correale C, Spinelli A, Arena V, Malesci A, Rutella S, Ploplis VA, Vetrano S, Danese S. The urokinase plasminogen activator receptor (uPAR) controls macrophage phagocytosis in intestinal inflammation. Gut 2015; 64:589-600. [PMID: 24848264 DOI: 10.1136/gutjnl-2013-305933] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Inflammation plays crucial roles in the pathogenesis of several chronic inflammatory disorders, including Crohn's disease (CD) and UC, the two major forms of IBD. The urokinase plasminogen activator receptor (uPAR) exerts pleiotropic functions over the course of both physiological and pathological processes. uPAR not only has a key role in fibrinolysis but also modulates the development of protective immunity. Additionally, uPAR supports extracellular matrix degradation and regulates cell migration, adhesion and proliferation, thus influencing the development of inflammatory and immune responses. This study aimed to evaluate the role of uPAR in the pathogenesis of IBD. DESIGN The functional role of uPAR was assessed in established experimental models of colitis. uPAR deficiency effects on cytokine release, polarisation and bacterial phagocytosis were analysed in colonic macrophages. uPAR expression was analysed in surgical specimens collected from normal subjects and patients with IBD. RESULTS In mice, uPAR expression is positively regulated as colitis progresses. uPAR-KO mice displayed severe inflammation compared with wild-type littermates, as indicated by clinical assessment, endoscopy and colon histology. The absence of uPAR led to an increased production of inflammatory cytokines by macrophages that showed an M1 polarisation and impaired phagocytosis. In human IBD, CD68(+) macrophages derived from the inflamed mucosa expressed low levels of uPAR. CONCLUSIONS These findings point to uPAR as an essential component of intestinal macrophage functions and unravel a new potential target to control mucosal inflammation in IBD.
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Affiliation(s)
- Marco Genua
- IBD Center, Humanitas Clinical and Research Center, Rozzano, Italy Department of Translational Medicine, University of Milan, Milan, Italy
| | - Silvia D'Alessio
- IBD Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Javier Cibella
- IBD Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | | | - Emanuela Sala
- IBD Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Carmen Correale
- IBD Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Antonino Spinelli
- Department of Translational Medicine, University of Milan, Milan, Italy Department of Surgery-IBD Surgery Unit, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Vincenzo Arena
- Department of Pediatric Hematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alberto Malesci
- IBD Center, Humanitas Clinical and Research Center, Rozzano, Italy Department of Translational Medicine, University of Milan, Milan, Italy
| | - Sergio Rutella
- Department of Pediatric Hematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Victoria A Ploplis
- W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, Indiana, USA
| | - Stefania Vetrano
- IBD Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Silvio Danese
- IBD Center, Humanitas Clinical and Research Center, Rozzano, Italy
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20
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Meijers B, Poesen R, Claes K, Dietrich R, Bammens B, Sprangers B, Naesens M, Storr M, Kuypers D, Evenepoel P. Soluble urokinase receptor is a biomarker of cardiovascular disease in chronic kidney disease. Kidney Int 2014; 87:210-6. [PMID: 24897037 DOI: 10.1038/ki.2014.197] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/26/2014] [Accepted: 04/03/2014] [Indexed: 12/30/2022]
Abstract
Soluble urokinase-type plasminogen activator receptor (suPAR) accumulates in patients with chronic kidney disease (CKD). In various non-CKD populations, suPAR has been proposed as a prognostic marker for mortality and cardiovascular disease. However, it is not known whether suPAR holds prognostic information in patients with mild-to-moderate CKD. In a prospective observational study of 476 patients with mild-to-moderate kidney disease, we examined multivariate associations between suPAR, overall mortality, and cardiovascular events. After a mean follow-up of 57 months, 52 patients died and 76 patients had at least one fatal or nonfatal cardiovascular event. Higher suPAR was directly and significantly associated with both overall mortality (univariate hazard ratio 5.35) and cardiovascular events (univariate hazard ratio 5.06). In multivariate analysis, suPAR remained significantly associated with cardiovascular events (full model, hazard ratio 3.05). Thus, in patients with mild-to-moderate CKD, suPAR concentrations show a clear, direct, and graded association with a higher risk for new-onset cardiovascular disease.
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Affiliation(s)
- Björn Meijers
- 1] UZ Leuven, Department of Nephrology, Leuven, Belgium [2] KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Ruben Poesen
- KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Kathleen Claes
- 1] UZ Leuven, Department of Nephrology, Leuven, Belgium [2] KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Ruth Dietrich
- Research and Development, Gambro Dialysatoren GmbH, Hechingen, Germany
| | - Bert Bammens
- 1] UZ Leuven, Department of Nephrology, Leuven, Belgium [2] KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Ben Sprangers
- 1] UZ Leuven, Department of Nephrology, Leuven, Belgium [2] KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Maarten Naesens
- 1] UZ Leuven, Department of Nephrology, Leuven, Belgium [2] KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Markus Storr
- Research and Development, Gambro Dialysatoren GmbH, Hechingen, Germany
| | - Dirk Kuypers
- 1] UZ Leuven, Department of Nephrology, Leuven, Belgium [2] KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
| | - Pieter Evenepoel
- 1] UZ Leuven, Department of Nephrology, Leuven, Belgium [2] KU Leuven, Department of Microbiology and Immunology, Leuven, Belgium
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Evaluation of Crohn’s disease activity: Initial validation of a magnetic resonance enterography global score (MEGS) against faecal calprotectin. Eur Radiol 2013; 24:277-87. [DOI: 10.1007/s00330-013-3010-z] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/30/2013] [Accepted: 08/16/2013] [Indexed: 02/06/2023]
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22
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Assa A, Hartman C, Weiss B, Broide E, Rosenbach Y, Zevit N, Bujanover Y, Shamir R. Long-term outcome of tumor necrosis factor alpha antagonist's treatment in pediatric Crohn's disease. J Crohns Colitis 2013; 7:369-76. [PMID: 22483567 DOI: 10.1016/j.crohns.2012.03.006] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 02/13/2012] [Accepted: 03/12/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Anti tumor necrosis factor alpha (TNFα) agents have become widely used in pediatric inflammatory bowel disease (IBD). So far, only few studies examined the long-term results of anti-TNFα treatment in children with IBD. METHODS The long-term outcome of pediatric patients with IBD was assessed retrospectively in a multicenter cohort of children treated with anti-TNFα beyond induction treatment. Short- and long-term response rates, predictors for loss of response, data on growth and laboratory parameters were assessed. RESULTS 120 patients [101 crohn's disease (CD), 19 ulcerative colitis (UC) or indeterminate colitis (IC)] received either infliximab or adalimumab. The mean age at initiation of anti-TNFα was 13.4 ± 3.9 years and the median duration of anti-TNFα treatment was 15 months (range: 2-90). Overall, 89% of the cohort experienced short-term response following induction. Response was associated with improvement in weight and BMI Z-scores (p<0.001) but not with linear growth. Responders experienced a significant decrease in erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) during treatment (p<0.001). Albumin and hemoglobin both improved but only albumin increased significantly (p<0.001). The cumulative probability of losing response to anti-TNFα treatment was 17%, 38%, and 49% after 1, 3, and 5 years, respectively. Responders had a significantly lower weight and BMI Z-scores at initiation of anti-TNFα treatment in compared to non-responders (p=0.04 and 0.02 respectively). CONCLUSIONS Our long term cohort supports the current evidence on the effectiveness and safety of anti-TNFα treatment in children with IBD. Response to treatment was interestingly associated with lower weight and BMI.
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Affiliation(s)
- Amit Assa
- Institute of Gastroenterology, Nutrition and Liver Disease, Schneider Children's Medical Center, Petach-Tikva, Israel.
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Bock ME, Price HE, Gallon L, Langman CB. Serum soluble urokinase-type plasminogen activator receptor levels and idiopathic FSGS in children: a single-center report. Clin J Am Soc Nephrol 2013; 8:1304-11. [PMID: 23620441 DOI: 10.2215/cjn.07680712] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES FSGS is the primary cause of childhood nephrotic syndrome leading to ESRD. Permeability factors, including circulating serum soluble urokinase-type plasminogen activator receptor (suPAR), have been postulated as putative causes in adults with primary FSGS. Similar results have yet to be proven in children. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This cross-sectional single-center study assessed the association of serum suPAR in children with FSGS or other glomerular and nonglomerular kidney diseases. RESULTS This study examined 110 samples retrieved from 99 individuals (between January 2011 and April 2012), aged 1-21 years; of these individuals, 20 had primary FSGS, 24 had non-FSGS glomerular disease, 26 had nonglomerular kidney disease, and 29 were healthy controls. suPAR levels were not significantly different in children with FSGS, non-FSGS glomerular disease, and healthy controls (P>0.05). However, suPAR levels (median [25%-75%]) were higher in children with nonglomerular kidney disease (3385 pg/ml [2695-4392]) versus FSGS (2487 pg/ml [2191-3351]; P<0.05). Female patients with nephrotic-range proteinuria (U-Pr/Cr >2) had lower suPAR levels than those without proteinuria (2380 pg/ml [2116-2571] versus 3125 pg/ml [2516-4198], respectively; P<0.001). This trend was not seen among male participants; suPAR levels in all female participants were lower than in male participants (P=0.03). Thirty-four patients studied were kidney transplant recipients; transplant status was not associated with suPAR levels in patients with FSGS or non-FSGS diagnoses, independent of proteinuria, race, or sex (P>0.05). CONCLUSIONS On the basis of these results, circulating suPAR is unlikely the leading cause for childhood idiopathic FSGS.
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Affiliation(s)
- Margret E Bock
- Divisions of Kidney Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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24
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Kolho KL, Valtonen E, Rintamäki H, Savilahti E. Soluble urokinase plasminogen activator receptor suPAR as a marker for inflammation in pediatric inflammatory bowel disease. Scand J Gastroenterol 2012; 47:951-5. [PMID: 22746351 DOI: 10.3109/00365521.2012.699549] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE In inflammatory bowel disease (IBD), more means to monitor early therapeutic response are needed. In pediatric IBD, blood inflammatory markers erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) may be low in 10 to 20% of patients with severe disease. Recently, soluble urokinase plasminogen activator receptor (suPAR) was described as a potential blood inflammatory marker in adult IBD. METHODS We tested the performance of suPAR by the start of therapy with glucocorticoids (n = 19) or TNF-α-antagonist (n = 16) in pediatric IBD (Crohn's disease n = 19, ulcerative colitis (UC) n = 16). RESULTS The levels of suPAR were low in both patient groups studied. There was no difference in the values regarding the presence of Crohn's disease or ulcerative colitis. Thus, all analyses were performed on the entire sample set. Glucocorticoid therapy, however, resulted in a significant decline in suPAR levels from a median of 3.06 to 2.54 ng/ml (p < 0.01). In contrast, TNF-α-antagonist had no effect. The suPAR levels did not associate with ESR or CRP or fecal calprotectin (FC). CONCLUSIONS In pediatric IBD, the suPAR levels in blood are low and do not reflect the level of intestinal inflammation assessed with FC. The introduction of corticoids, however, results in a decline of suPAR levels in blood but not reflect therapeutic response to TNF-α-antagonist. Thus, suPAR is of limited value in assessing systemic inflammatory responses in pediatric IBD.
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Affiliation(s)
- Kaija-Leena Kolho
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland.
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25
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Backes Y, van der Sluijs KF, Mackie DP, Tacke F, Koch A, Tenhunen JJ, Schultz MJ. Usefulness of suPAR as a biological marker in patients with systemic inflammation or infection: a systematic review. Intensive Care Med 2012; 38:1418-28. [PMID: 22706919 PMCID: PMC3423568 DOI: 10.1007/s00134-012-2613-1] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 05/20/2012] [Indexed: 12/16/2022]
Abstract
Purpose Systemic levels of soluble urokinase-type plasminogen activator receptor (suPAR) positively correlate with the activation level of the immune system. We reviewed the usefulness of systemic levels of suPAR in the care of critically ill patients with sepsis, SIRS, and bacteremia, focusing on its diagnostic and prognostic value. Methods A PubMed search on suPAR was conducted, including manual cross-referencing. The list of papers was narrowed to original studies of critically ill patients. Ten papers on original studies of critically ill patients were identified that report on suPAR in sepsis, SIRS, or bacteremia. Results Systematic levels of suPAR have little diagnostic value in critically ill patients with sepsis, SIRS, or bacteremia. Systemic levels of suPAR, however, have superior prognostic power over other commonly used biological markers in these patients. Mortality prediction by other biological markers or severity-of-disease classification system scores improves when combining them with suPAR. Systemic levels of suPAR correlate positively with markers of organ dysfunction and severity-of-disease classification system scores. Finally, systemic levels of suPAR remain elevated for prolonged periods after admission and only tend to decline after several weeks. Notably, the type of assay used to measure suPAR as well as the age of the patients and underlying disease affect systemic levels of suPAR. Conclusions The diagnostic value of suPAR is low in patients with sepsis. Systemic levels of suPAR have prognostic value, and may add to prognostication of patients with sepsis or SIRS complementing severity-of-disease classification systems and other biological markers.
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Affiliation(s)
- Yara Backes
- Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Koppensteiner W, Auersperg V, Halwachs-Baumann G. The use of inflammatory markers as a method for discharging patients post hip or knee arthroplasty. Clin Chem Lab Med 2011; 49:1647-53. [PMID: 21702697 DOI: 10.1515/cclm.2011.657] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Complications after orthopaedic surgery have a substantial impact on resources, including the financial resources of the health-care system. Early detection of patients developing complications, thus excluding those patients without complications should have a major impact on patients' management. METHODS We evaluated the prognostic value of blood levels of inflammatory markers (interleukin-6, C-reactive protein, total white blood cell count) for complications after primary hip and knee arthroplasty in a routine setting, and their impact on patient management. First, the three inflammatory markers were evaluated in 68 consecutive patients treated at the Department of Orthopaedics. Laboratory markers were measured on days 2 and 4 after surgery. Second, patient management before and after adapting the routine order for laboratory parameters after arthroplasty were evaluated. RESULTS We could show that interleukin-6 and the C-reactive protein had an almost equal negative predictive value for the exclusion of postsurgical complications. Nevertheless, interleukin-6 returned below its reference levels almost 2 days earlier compared to the other markers. This made an earlier discharge of patients with presumable complications-less postsurgical process possible. CONCLUSIONS So, the total number of patients treated as well as the financial reimbursement could be increased and concurrently occupancy days and averaged length of stay were reduced.
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