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Association of Preoperative Basal Inflammatory State, Measured by Plasma suPAR Levels, with Intraoperative Sublingual Microvascular Perfusion in Patients Undergoing Major Non-Cardiac Surgery. J Clin Med 2022; 11:jcm11123326. [PMID: 35743397 PMCID: PMC9225100 DOI: 10.3390/jcm11123326] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/02/2022] [Accepted: 06/08/2022] [Indexed: 02/04/2023] Open
Abstract
It remains unknown whether chronic systemic inflammation is associated with impaired microvascular perfusion during surgery. We evaluated the association between the preoperative basal inflammatory state, measured by plasma soluble urokinase-type plasminogen activator receptor (suPAR) levels, and intraoperative sublingual microcirculatory variables in patients undergoing major non-cardiac surgery. Plasma suPAR levels were determined in 100 non-cardiac surgery patients using the suPARnostic® quick triage lateral flow assay. We assessed sublingual microcirculation before surgical incision and every 30 min during surgery using Sidestream Darkfield (SDF+) imaging and determined the De Backer score, the Consensus Proportion of Perfused Vessels (Consensus PPV), and the Consensus PPV (small). Elevated suPAR levels were associated with lower intraoperative De Backer score, Consensus PPV, and Consensus PPV (small). For each ng mL−1 increase in suPAR, De Backer score, Consensus PPV, and Consensus PPV (small) decreased by 0.7 mm−1, 2.5%, and 2.8%, respectively, compared to baseline. In contrast, CRP was not significantly correlated with De Backer score (r = −0.034, p = 0.36), Consensus PPV (r = −0.014, p = 0.72) or Consensus PPV Small (r = −0.037, p = 0.32). Postoperative De Backer score did not change significantly from baseline (5.95 ± 3.21 vs. 5.89 ± 3.36, p = 0.404), while postoperative Consensus PPV (83.49 ± 11.5 vs. 81.15 ± 11.8, p < 0.001) and Consensus PPV (small) (80.87 ± 13.4 vs. 78.72 ± 13, p < 0.001) decreased significantly from baseline. In conclusion, elevated preoperative suPAR levels were associated with intraoperative impairment of sublingual microvascular perfusion in patients undergoing elective major non-cardiac surgery.
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Śmiłowska K, Śmiłowski M, Partyka R, Kokocińska D, Jałowiecki P. Personalised Approach to Diagnosing and Managing Ischemic Stroke with a Plasma-Soluble Urokinase-Type Plasminogen Activator Receptor. J Pers Med 2022; 12:jpm12030457. [PMID: 35330458 PMCID: PMC8953259 DOI: 10.3390/jpm12030457] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The increasing incidence of ischemic stroke has led to the search for a novel biomarker to predict the course of disease and the risk of mortality. Recently, the role of the soluble urokinase plasminogen activator receptor (suPAR) as a biomarker and indicator of immune system activation has been widely examined. Therefore, the aim of the current study was to assess the dynamics of changes in serum levels of suPAR in ischemic stroke and to evaluate the prognostic value of suPAR in determining mortality risk. Methods: Eighty patients from the Department of Neurology, diagnosed with ischemic stroke, were enrolled in the study. Residual blood was obtained from all the patients on the first, third and seventh days after their ischemic stroke and the concentrations of suPAR and C-reactive protein (CRP), as well as the number of leukocytes and National Institute of Health’s Stroke Scale (NIHSS) scores, were evaluated. Results: On the first day of ischemic stroke, the average suPAR concentration was 6.55 ng/mL; on the third day, it was 8.29 ng/mL; on the seventh day, it was 9.16 ng/mL. The average CRP concentration on the first day of ischemic stroke was 4.96 mg/L; on the third day, it was 11.76 mg/L; on the seventh day, it was 17.17 mg/L. The number of leukocytes on the first day of ischemic stroke was 7.32 × 103/mm3; on the third day, it was 9.27 × 103/mm3; on the seventh day, it was 10.41 × 103/mm3. Neurological condition, which was assessed via the NIHSS, on the first day of ischemic stroke, was scored at 10.71 points; on the third day, it was scored at 12.34 points; on the seventh day, it was scored at 13.75 points. An increase in the values of all the evaluated parameters on the first, third and seventh days of hospitalisation was observed. The patients with hypertension, ischemic heart disease and type 2 diabetes showed higher suPAR and CRP concentrations at the baseline as well as on subsequent days of hospitalisation. The greatest sensitivity and specificity were characterised by suPAR-3, where a value above 10.5 ng/mL resulted in a significant increase in mortality risk. Moreover, an NIHSS-1 score above 12 points and a CRP-3 concentration above 15.6 mg/L significantly increased the risk of death in the course of the disease. Conclusions: The plasma suPAR concentration after ischemic stroke is strongly related to the patient’s clinical status, with a higher concentration on the first and third days of stroke resulting in a poorer prognosis at a later stage of treatment. Therefore, assessing the concentration of this parameter has important prognostic value.
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Affiliation(s)
- Katarzyna Śmiłowska
- Department of Emergency Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-055 Katowice, Poland; (R.P.); (D.K.); (P.J.)
- Department of Neurology, 5th Regional Hospital in Sosnowiec, Plac Medyków 1, 41-200 Sosnowiec, Poland
- Correspondence:
| | - Marek Śmiłowski
- Department of Hematology and Bone Marrow Transplantation, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Robert Partyka
- Department of Emergency Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-055 Katowice, Poland; (R.P.); (D.K.); (P.J.)
| | - Danuta Kokocińska
- Department of Emergency Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-055 Katowice, Poland; (R.P.); (D.K.); (P.J.)
| | - Przemysław Jałowiecki
- Department of Emergency Medicine, Faculty of Medical Sciences, Medical University of Silesia, 40-055 Katowice, Poland; (R.P.); (D.K.); (P.J.)
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Chalkias A, Laou E, Kolonia K, Ragias D, Angelopoulou Z, Mitsiouli E, Kallemose T, Smith-Hansen L, Eugen-Olsen J, Arnaoutoglou E. Elevated preoperative suPAR is a strong and independent risk marker for postoperative complications in patients undergoing major noncardiac surgery (SPARSE). Surgery 2021; 171:1619-1625. [PMID: 34736789 DOI: 10.1016/j.surg.2021.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients undergoing major surgery are often at risk of developing postoperative complications. We investigated whether a preoperative marker of chronic inflammation, soluble urokinase plasminogen activator receptor, can aid in identifying patients at high risk for postoperative complications, morbidity, and mortality. METHODS In this prospective observational study (ClinicalTrials.gov identifier: NCT03851965), EDTA blood was collected from consecutive adult White patients scheduled for major noncardiac surgery with expected duration ≥2 hours under general anesthesia. Inclusion criteria were age ≥18 years and American Society of Anesthesiologists physical status I to IV. Plasma soluble urokinase plasminogen activator receptor levels were determined using the suPARnostic quick triage lateral flow assay. The primary endpoint was postoperative complications defined as presence of any complication and/or admission to intensive care unit and/or mortality within the first 90 postoperative days. RESULTS Preoperative soluble urokinase plasminogen activator receptor had an odds ratio of 1.50 (95% confidence interval: 1.24-1.82) for every ng/mL increase. When including age, sex, American Society of Anesthesiologists score, C-reactive protein, and grouped soluble urokinase plasminogen activator receptor in multivariate analysis, patients with soluble urokinase plasminogen activator receptor between 5.5 and 10 ng/mL had an odds ratio of 11.2 (confidence interval: 3.1-40.8) and patients with soluble urokinase plasminogen activator receptor >10 ng/mL had an odds ratio of 19.9 (95% confidence interval: 4.3-92.9) compared to patients with soluble urokinase plasminogen activator receptor ≤5.5 ng/mL, respectively. Receiver operating characteristic analysis of soluble urokinase plasminogen activator receptor showed an area under the curve of 0.82 (confidence interval: 0.72-0.91). Receiver operating characteristic analysis combining age, sex, C-reactive protein levels, and American Society of Anesthesiologists score and had an area under the curve of 0.71 (95% confidence interval: 0.61-0.82). Adding soluble urokinase plasminogen activator receptor to this model increased the area under the curve to 0.83 (95% confidence interval: 0.74-0.92) (P = .033). CONCLUSION Preoperative soluble urokinase plasminogen activator receptor provided strong and independent predictive value on postoperative complications in White patients undergoing major noncardiac surgery.
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Affiliation(s)
- Athanasios Chalkias
- Faculty of Medicine, Department of Anesthesiology, University of Thessaly, Larisa, Greece; Outcomes Research Consortium, Cleveland, OH.
| | - Eleni Laou
- Faculty of Medicine, Department of Anesthesiology, University of Thessaly, Larisa, Greece
| | - Konstantina Kolonia
- Faculty of Medicine, Department of Anesthesiology, University of Thessaly, Larisa, Greece
| | - Dimitrios Ragias
- Faculty of Medicine, Department of Anesthesiology, University of Thessaly, Larisa, Greece
| | | | - Eleni Mitsiouli
- Faculty of Medicine, Department of Anesthesiology, University of Thessaly, Larisa, Greece
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Lars Smith-Hansen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Hvidovre, Denmark
| | - Eleni Arnaoutoglou
- Faculty of Medicine, Department of Anesthesiology, University of Thessaly, Larisa, Greece
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Blomberg K, Hansen TF, Brasen CL, Madsen JB, Jensen LH, Thomsen CB. The Soluble Urokinase-Type Plasminogen Activator Receptor as a Biomarker for Survival and Early Treatment Effect in Metastatic Colorectal Cancer. Cancers (Basel) 2021; 13:5100. [PMID: 34680247 PMCID: PMC8534079 DOI: 10.3390/cancers13205100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 12/17/2022] Open
Abstract
The soluble urokinase-type plasminogen activator receptor (suPAR) is prognostic for overall survival (OS) in colorectal cancer (CRC). Our study explored the association between baseline suPAR and OS and progression-free survival (PFS) in metastatic CRC (mCRC). It is also the first study to explore the association between the initial change in suPAR level and OS, PFS and the first CT response evaluation. The study included 132 patients with mCRC treated with chemotherapy (FOLFIRI) with or without an EGFR-inhibitor. Blood samples were drawn before the first treatment cycle and in between the first and second treatment cycle. suPAR levels were determined using an ELISA assay. Using the Kaplan-Meyer method, we demonstrated a significantly shorter OS for patients with suPAR levels above the median (HR = 1.79, 95%CI = 1.10-2.92, p = 0.01). We also showed association between plasma suPAR level, gender and performance status (PS). However, we could not show any association with PFS, and analysis on the change in suPAR level provided no significant results. The results showing association between baseline suPAR and OS are in line with previous findings.
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Affiliation(s)
- Kristian Blomberg
- Department of Health Science, University of Southern Denmark, 5000 Odense, Denmark;
- Danish Colorectal Cancer Center South, Department of Oncology, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (T.F.H.); (L.H.J.)
| | - Torben F. Hansen
- Danish Colorectal Cancer Center South, Department of Oncology, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (T.F.H.); (L.H.J.)
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark;
| | - Claus L. Brasen
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark;
- Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark;
| | - Jeppe B. Madsen
- Department of Biochemistry and Immunology, Lillebaelt Hospital, University Hospital of Southern Denmark, 7100 Vejle, Denmark;
| | - Lars H. Jensen
- Danish Colorectal Cancer Center South, Department of Oncology, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (T.F.H.); (L.H.J.)
- Department of Regional Health Research, University of Southern Denmark, 5000 Odense, Denmark;
- Open Patient Data Explorative Network, The Clinical Institute, Odense University Hospital, 5000 Odense, Denmark
| | - Caroline B. Thomsen
- Danish Colorectal Cancer Center South, Department of Oncology, University Hospital of Southern Denmark, 7100 Vejle, Denmark; (T.F.H.); (L.H.J.)
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Ahn SB, Kamath KS, Mohamedali A, Noor Z, Wu JX, Pascovici D, Adhikari S, Cheruku HR, Guillemin GJ, McKay MJ, Nice EC, Baker MS. Use of a Recombinant Biomarker Protein DDA Library Increases DIA Coverage of Low Abundance Plasma Proteins. J Proteome Res 2021; 20:2374-2389. [PMID: 33752330 DOI: 10.1021/acs.jproteome.0c00898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Credible detection and quantification of low abundance proteins from human blood plasma is a major challenge in precision medicine biomarker discovery when using mass spectrometry (MS). In this proof-of-concept study, we employed a mixture of selected recombinant proteins in DDA libraries to subsequently identify (not quantify) cancer-associated low abundance plasma proteins using SWATH/DIA. The exemplar DDA recombinant protein spectral library (rPSL) was derived from tryptic digestion of 36 recombinant human proteins that had been previously implicated as possible cancer biomarkers from both our own and other studies. The rPSL was then used to identify proteins from nondepleted colorectal cancer (CRC) EDTA plasmas by SWATH-MS. Most (32/36) of the proteins used in the rPSL were reliably identified from CRC plasma samples, including 8 proteins (i.e., BTC, CXCL10, IL1B, IL6, ITGB6, TGFα, TNF, TP53) not previously detected using high-stringency protein inference MS according to PeptideAtlas. The rPSL SWATH-MS protocol was compared to DDA-MS using MARS-depleted and postdigestion peptide fractionated plasmas (here referred to as a human plasma DDA library). Of the 32 proteins identified using rPSL SWATH, only 12 could be identified using DDA-MS. The 20 additional proteins exclusively identified using the rPSL SWATH approach were almost exclusively lower abundance (i.e., <10 ng/mL) proteins. To mitigate justified FDR concerns, and to replicate a more typical library creation approach, the DDA rPSL library was merged with a human plasma DDA library and SWATH identification repeated using such a merged library. The majority (33/36) of the low abundance plasma proteins added from the rPSL were still able to be identified using such a merged library when high-stringency HPP Guidelines v3.0 protein inference criteria were applied to our data set. The MS data set has been deposited to ProteomeXchange Consortium via the PRIDE partner repository (PXD022361).
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Affiliation(s)
- Seong Beom Ahn
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Karthik S Kamath
- Australian Proteome Analysis Facility (APAF), Department of Molecular Sciences, Faculty of Science and Engineering, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Abidali Mohamedali
- Department of Molecular Sciences, Faculty of Science and Engineering, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Zainab Noor
- ProCan, Children's Medical Research Institute, The University of Sydney, Westmead, Newtown, NSW 2042, Australia
| | - Jemma X Wu
- Australian Proteome Analysis Facility (APAF), Department of Molecular Sciences, Faculty of Science and Engineering, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Dana Pascovici
- Australian Proteome Analysis Facility (APAF), Department of Molecular Sciences, Faculty of Science and Engineering, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Subash Adhikari
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Harish R Cheruku
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Gilles J Guillemin
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Matthew J McKay
- Australian Proteome Analysis Facility (APAF), Department of Molecular Sciences, Faculty of Science and Engineering, Macquarie University, Macquarie Park, NSW 2109, Australia
| | - Edouard C Nice
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3800, Australia
| | - Mark S Baker
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, NSW 2109, Australia
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Rolff HC, Christensen IJ, Svendsen LB, Wilhelmsen M, Lund IK, Thurison T, Høyer-Hansen G, Illemann M, Nielsen HJ. The concentration of the cleaved suPAR forms in pre- and postoperative plasma samples improves the prediction of survival in colorectal cancer: A nationwide multicenter validation and discovery study. J Surg Oncol 2019; 120:1404-1411. [PMID: 31646652 DOI: 10.1002/jso.25733] [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: 05/27/2019] [Accepted: 09/19/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim was to evaluate the prognostic biomarker potential of the soluble urokinase-type plasminogen activator receptor (suPAR) in plasma samples collected pre- and postoperatively from patients resected for colorectal cancer (CRC). METHODS Patients with CRC were recruited prospectively at six centers from 2006 to 2008. Preoperative plasma samples were available from 494 patients and from 328 of these patients at 6 months postoperatively. Determinations of intact soluble uPAR (suPAR) suPAR(I-III) and the cleaved forms suPAR(I-III) + (II-III) and uPAR(I) were performed. Clinical data were retrieved retrospectively. RESULTS In a multivariable model based on preoperative plasma samples suPAR(I-III) + (II-III) and uPAR(I) showed an independent statistically significant association to long term survival. When including the change in biomarker level between the pre- and postoperatively samples the hazard ratios were 3.06 (95% confidence interval [CI], 1.78-5.28; P < .0001) and 2.24 (95% CI, 1.59-3.16; P < .0001) for suPAR(I-III) + (II-III) and uPAR(I), respectively. A one-unit decrease in biomarker levels between the pre- and postoperative levels resulted in a 55% and 34% reduction in the risk estimate of death for suPAR(I-III) + (II-III) and uPAR(I), respectively. CONCLUSION This study validates previously findings regarding the prognostic significance of suPAR in preoperative samples. The inclusion of postoperative samples added further prognostic information.
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Affiliation(s)
- Hans C Rolff
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark.,Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen, Denmark.,The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark
| | - Ib J Christensen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Lars B Svendsen
- Department of Surgical Gastroenterology and Transplantation, Rigshospitalet, Copenhagen, Denmark
| | - Michael Wilhelmsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Ida K Lund
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark.,Biotech Research Innovation Center - BRIC, University of Copenhagen, Copenhagen, Denmark
| | - Tine Thurison
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark.,Biotech Research Innovation Center - BRIC, University of Copenhagen, Copenhagen, Denmark
| | - Gunilla Høyer-Hansen
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark.,Biotech Research Innovation Center - BRIC, University of Copenhagen, Copenhagen, Denmark
| | - Martin Illemann
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark.,Biotech Research Innovation Center - BRIC, University of Copenhagen, Copenhagen, Denmark
| | - Hans J Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
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Roberts A, Tripathi PP, Gandhi S. Graphene nanosheets as an electric mediator for ultrafast sensing of urokinase plasminogen activator receptor-A biomarker of cancer. Biosens Bioelectron 2019; 141:111398. [PMID: 31176112 DOI: 10.1016/j.bios.2019.111398] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 12/14/2022]
Abstract
Fluorine doped tin oxide (FTO) electrochemical immunosensor has been developed for rapid detection of urokinase type plasminogen activator receptor (uPAR) - a biomarker for cancer. uPAR is a GPI-anchored cell membrane receptor that shows increased expression in many types of human cancers which include breast, prostate, colorectal, and non-small cell lung cancer. In this study, a novel ultrasensitive FTO graphene nanosheets based electrode was used as a working probe to analyze the interaction between urokinase plasminogen activator (uPA) and monoclonal uPAR antibody (Ab). Graphene nanosheets (GNS) exhibited high conductivity, thereby increasing the sensitivity of the immunochemical assay. GNS were coupled with uPAR-Ab via carbodiimide activation chemistry with 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide (EDC)/N-hydroxysuccinimide (NHS) as a heterobifunctional crosslinker. The confirmation of immobilization events was done by biophysical methods such as UV-Vis spectroscopy, fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), atomic force microscopy (AFM), differential pulse (DPV), and cyclic voltammetry (CV). The immobilization conditions were optimized in accordance with the best sensor response. Under optimum conditions, the proposed sensor displayed wide linear detection range (1 fM to 1 μM) with a detection limit of 4.8 fM in standard. The developed sensor was profitably engaged to detect uPA in spiked serum samples up to 9.2 pM. Furthermore, the developed uPAR immunosensor showed good reproducibility, repeatability, and storage stability (75% of initial activity observed up to 4 weeks). FTO/GNS/uPAR-Ab/uPA-Ag immunosensor displayed acceptable performance for detection of uPA and exhibited low detection limit with high reproducibility. The proposed immunosensor is 'easy to use', highly specific, and can be used as a quantitative tool making it a tenable alternate for the detection of uPAR in cancer patients.
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Affiliation(s)
- Akanksha Roberts
- DBT-National Institute of Animal Biotechnology, Hyderabad, 500032, Telangana, India
| | - Prem Prakash Tripathi
- CSIR-Indian Institute of Chemical Biology (CSIR-IICB), Kolkata, 700091, India; IICB-Translational Research Unit of Excellence, Kolkata, 700091, India
| | - Sonu Gandhi
- DBT-National Institute of Animal Biotechnology, Hyderabad, 500032, Telangana, India.
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suPAR is associated with risk of future acute surgery and post-operative mortality in acutely admitted medical patients. Scand J Trauma Resusc Emerg Med 2018; 26:11. [PMID: 29391054 PMCID: PMC5796401 DOI: 10.1186/s13049-018-0478-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 01/15/2018] [Indexed: 12/13/2022] Open
Abstract
Background Acutely admitted medical patients are often fragile and in risk of future surgery. The biomarker soluble urokinase plasminogen activator receptor (suPAR) is a predictor of readmission and mortality in the acute care setting. We aimed to investigate if suPAR also predicts acute surgery, which is associated with higher mortality than elective surgery, and if it predicts post-operative mortality. Methods A retrospective registry-based cohort study of 17,312 patients admitted to an acute medical unit in Denmark, from 18 November 2013 until 30 September 2015. The first admission with available suPAR was defined as the index admission, and patients were followed via national registries until 1 January 2016. The risk of acute surgery during the entire follow-up period as well as the 90-day post-operative mortality risk was modeled by Cox regression analyses adjusted for sex, age, C-reactive protein, and Charlson Comorbidity Index (Charlson Score). Results Acute surgery was carried out on 2404 patients (13.9%) after a median of 45 days (interquartile range 5–186) following the index admission. Patients receiving acute surgery had higher baseline suPAR compared with patients receiving elective- or no surgery (p < 0.0001). The hazard ratio (HR) for acute surgery was 1.50 (95% confidence interval (CI): 1.42–1.59) for every doubling of the suPAR level in the adjusted Cox regression analysis. Death within 90 days occurred in 439 (18.3%) patients receiving acute surgery, and the adjusted HR for post-operative mortality was 1.73 (95% CI: 1.52–1.95). Discussion Elevated levels of suPAR in acutely admitted medical patients were independently associated with increased risk of future acute surgery as well as with 90-day post-operative mortality. Trial registration This retrospective registry-based cohort study was approved by the Danish Health and Medicines authority (reference no. 3–3013-1061/1). All processing of personal data followed national guidelines, and the project was approved by the Danish Data Protection Agency (reference no. HVH-2014-018, 02767).
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Urokinase-type plasminogen activator receptor (uPAR) expression enhances invasion and metastasis in RAS mutated tumors. Sci Rep 2017; 7:9388. [PMID: 28839232 PMCID: PMC5571185 DOI: 10.1038/s41598-017-10062-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/21/2017] [Indexed: 01/08/2023] Open
Abstract
The urokinase-type plasminogen activator receptor (uPAR) is a GPI-anchored cell membrane receptor that focuses urokinase (uPA) proteolytic activity on the cell surface. Its expression is increased in many human cancers, including non-small cell lung cancer (NSCLC) and colorectal cancer (CRC), and correlates with a poor prognosis and early invasion and metastasis. uPAR is able to control, through a cross-talk with tyrosine kinase receptors, the shift between tumor dormancy and proliferation, that usually precedes metastasis formation. Therefore, we investigated the role of uPAR expression in RAS mutated NSCLC and CRC cells. In this study we provided evidence, for the first time, that RAS mutational condition is functionally correlated to uPAR overexpression in NSCLC and CRC cancer cell lines and patient-derived tissue samples. Moreover, oncogenic features related to uPAR overexpression in RAS mutated NSCLC and CRC, such as adhesion, migration and metastatic process may be targeted, in vitro and in vivo, by new anti-uPAR small molecules, specific inhibitors of uPAR-vitronectin interaction. Therefore, anti-uPAR drugs could represent an effective pharmacological strategy for NSCLC and CRC patients carrying RAS mutations.
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Rasmussen LJH, Schultz M, Gaardsting A, Ladelund S, Garred P, Iversen K, Eugen‐Olsen J, Helms M, David KP, Kjær A, Lebech A, Kronborg G. Inflammatory biomarkers and cancer: CRP and suPAR as markers of incident cancer in patients with serious nonspecific symptoms and signs of cancer. Int J Cancer 2017; 141:191-199. [PMID: 28393357 PMCID: PMC5518177 DOI: 10.1002/ijc.30732] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/29/2017] [Accepted: 04/03/2017] [Indexed: 12/18/2022]
Abstract
In Denmark, patients with serious nonspecific symptoms and signs of cancer (NSSC) are referred to the diagnostic outpatient clinics (DOCs) where an accelerated cancer diagnostic program is initiated. Various immunological and inflammatory biomarkers have been associated with cancer, including soluble urokinase plasminogen activator receptor (suPAR) and the pattern recognition receptors (PRRs) pentraxin-3, mannose-binding lectin, ficolin-1, ficolin-2 and ficolin-3. We aimed to evaluate these biomarkers and compare their diagnostic ability to classical biomarkers for diagnosing cancer in patients with NSSC. Patients were included from the DOC, Department of Infectious Diseases, Copenhagen University Hospital Hvidovre. Patients were given a final diagnosis based on the combined results from scans, blood work and physical examination. Weight loss, Charlson score and previous cancer were registered on admission, and plasma concentrations of biomarkers were measured. The primary outcome was incident cancer within 1 year. Out of 197 patients included, 39 patients (19.8%) were diagnosed with cancer. Patients with cancer were significantly older and had a higher burden of comorbidities and previous cancer diagnoses compared to patients who were not diagnosed with cancer. Previous cancer, C-reactive protein (CRP) and suPAR were significantly associated with newly diagnosed cancer during follow-up in multiple logistic regression analyses adjusted for age, sex and CRP. Neither any of the PRRs investigated nor self-reported weight loss was associated with cancer. In this study, previous cancer, CRP and suPAR were significantly associated with cancer diagnosis in patients with NSSC. Ficolin-1-3, MBL and pentraxin-3 were not associated with cancer.
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Affiliation(s)
| | - Martin Schultz
- Department of CardiologyCopenhagen University Hospital HerlevHerlevDenmark
| | - Anne Gaardsting
- Department of Infectious DiseasesCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Steen Ladelund
- Clinical Research Centre, Copenhagen University Hospital HvidovreHvidovreDenmark
| | - Peter Garred
- Laboratory of Molecular MedicineDepartment of Clinical Immunology, Rigshospitalet, Faculty of Health and Medical Sciences, University of CopenhagenCopenhagenDenmark
| | - Kasper Iversen
- Department of CardiologyCopenhagen University Hospital HerlevHerlevDenmark
| | - Jesper Eugen‐Olsen
- Clinical Research Centre, Copenhagen University Hospital HvidovreHvidovreDenmark
| | - Morten Helms
- Department of Infectious DiseasesCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Kim Peter David
- Department of Infectious DiseasesCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Andreas Kjær
- Department of Clinical PhysiologyNuclear Medicine & PET and Cluster for Molecular Imaging, RigshospitaletDenmark
| | - Anne‐Mette Lebech
- Department of Infectious DiseasesCopenhagen University Hospital HvidovreHvidovreDenmark
| | - Gitte Kronborg
- Department of Infectious DiseasesCopenhagen University Hospital HvidovreHvidovreDenmark
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11
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Kristensen G, Berg KD, Lippert S, Christensen IJ, Brasso K, Høyer-Hansen G, Røder MA. Plasma levels of intact and cleaved urokinase plasminogen activator receptor (uPAR) in men with clinically localised prostate cancer. J Clin Pathol 2017; 70:1063-1068. [PMID: 28607123 DOI: 10.1136/jclinpath-2017-204475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 01/07/2023]
Abstract
AIMS Lymph node metastasis (N1) is an adverse prognostic factor for men with clinically localised prostate cancer (PCa), but the prediction of N1 disease remains difficult. Urokinase plasminogen activator receptor (uPAR) plays an important role in angiogenesis and tumorigenesis. We analysed whether plasma levels of the soluble uPAR forms uPAR(I-III), uPAR(II-III) and uPAR(I) were associated with the risk of N1 disease in men with clinically localised PCa. METHODS The present study includes all men (n=518) who underwent radical prostatectomy (RP) for clinically localised PCa, 29 of whom had N1 disease. Soluble uPAR forms were measured using three time-resolved fluorescence immunoassays. The prognostic value of the different uPAR forms together with clinicopathological parameters for N1 disease were analysed using logistic regression, receiver operating characteristic (ROC) regression analysis and quantified using the areas under the ROC curve (AUC). RESULTS All soluble uPAR levels were significantly (p=0.03) higher in patients with N1 disease compared with patients with N0/x disease. ROC curves including clinical tumour stage, biopsy Gleason score, prostate-specific antigen and percent positive biopsies had an AUC of 87.7% for prediction of N1 disease. With the addition of uPAR(I) to the model, the AUC increased to 88.4%. CONCLUSIONS Addition of uPAR(I) level to known diagnostic parameters did not increase the prediction of N1 disease following RP in men with clinically localised PCa. Our results indicate that the plasma levels at diagnosis of the different uPAR forms do not hold important predictive or prognostic information in men with clinically localised PCa.
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Affiliation(s)
- Gitte Kristensen
- Department of Urology, Rigshospitalet, Copenhagen Prostate Cancer Center, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Drimer Berg
- Department of Urology, Rigshospitalet, Copenhagen Prostate Cancer Center, University of Copenhagen, Copenhagen, Denmark
| | - Solvej Lippert
- Department of Urology, Rigshospitalet, Copenhagen Prostate Cancer Center, University of Copenhagen, Copenhagen, Denmark
| | - Ib Jarle Christensen
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark.,Department of Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark
| | - Klaus Brasso
- Department of Urology, Rigshospitalet, Copenhagen Prostate Cancer Center, University of Copenhagen, Copenhagen, Denmark
| | - Gunilla Høyer-Hansen
- Biotech Research and Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark.,The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark
| | - Martin Andreas Røder
- Department of Urology, Rigshospitalet, Copenhagen Prostate Cancer Center, University of Copenhagen, Copenhagen, Denmark
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12
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Association between suPAR and cardiac diastolic dysfunction among patients with preserved ejection fraction. Heart Vessels 2017; 32:1327-1336. [DOI: 10.1007/s00380-017-1002-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/26/2017] [Indexed: 12/22/2022]
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13
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Guo H, Zhou LX, Ma H, Liu B, Cheng J, Ma YY, Zhao L. Soluble urokinase-type plasminogen activator receptor and urokinase-type plasminogen activator receptor contribute to chemoresistance in leukemia. Oncol Lett 2017; 14:383-389. [PMID: 28693180 DOI: 10.3892/ol.2017.6150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 02/23/2017] [Indexed: 12/29/2022] Open
Abstract
The soluble urokinase-type plasminogen activator receptor (suPAR) and the urokinase-type plasminogen activator receptor (uPAR) have been proposed as useful biomarkers of tumor progression. Recently, suPAR was associated with chemoresistance in lung cancer. However, its clinical significance in leukemia has not previously been investigated. The present study examined the plasma levels of suPAR and the expression of the uPAR on bone marrow (BM) cells in 86 patients with leukemia at diagnosis prior to chemotherapy and 26 normal subjects (control group). The plasma suPAR levels were measured using ELISA, whilst uPAR expression was assayed by flow cytometry analysis. In addition, cell surface uPAR expression on K562 and multidrug-resistant K562/ADM cell lines was studied by western blotting. On admission and follow-up, the levels of suPAR in patients with leukemia were significantly increased compared with controls. Systemic levels of suPAR were strongly associated with the numbers of white blood cells. A case was defined as uPAR-positive (uPAR+) if >20% of the gated cells expressed uPAR. In comparison with 26 healthy BM samples that were negative for uPAR expression, 48 (55.8%) of the 86 leukemia patients were uPAR+. uPAR expression on the cell surface of multidrug-resistant K562/ADM cells was increased compared with that on K562 cells. In conclusion, plasma suPAR expression may be a useful marker for subtype classification of patients with leukemia and cell surface uPAR may be associated with resistance to chemotherapy or disease progression.
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Affiliation(s)
- Hong Guo
- Critical Care Medicine Department, The First Affiliated Hospital, Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Lan-Xia Zhou
- Central Laboratory, The First Affiliated Hospital, Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Haizhen Ma
- Department of Hematology, The First Affiliated Hospital, Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Bei Liu
- Department of Hematology, The First Affiliated Hospital, Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Juan Cheng
- Department of Hematology, The First Affiliated Hospital, Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Yun-Yun Ma
- Central Laboratory, The First Affiliated Hospital, Lanzhou University, Lanzhou, Gansu 730000, P.R. China
| | - Li Zhao
- Central Laboratory, The First Affiliated Hospital, Lanzhou University, Lanzhou, Gansu 730000, P.R. China
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14
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uPAR-targeted multimodal tracer for pre- and intraoperative imaging in cancer surgery. Oncotarget 2016; 6:14260-73. [PMID: 25895028 PMCID: PMC4546465 DOI: 10.18632/oncotarget.3680] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/03/2015] [Indexed: 12/19/2022] Open
Abstract
Pre- and intraoperative diagnostic techniques facilitating tumor staging are of paramount importance in colorectal cancer surgery. The urokinase receptor (uPAR) plays an important role in the development of cancer, tumor invasion, angiogenesis, and metastasis and over-expression is found in the majority of carcinomas. This study aims to develop the first clinically relevant anti-uPAR antibody-based imaging agent that combines nuclear (111In) and real-time near-infrared (NIR) fluorescent imaging (ZW800-1). Conjugation and binding capacities were investigated and validated in vitro using spectrophotometry and cell-based assays. In vivo, three human colorectal xenograft models were used including an orthotopic peritoneal carcinomatosis model to image small tumors. Nuclear and NIR fluorescent signals showed clear tumor delineation between 24h and 72h post-injection, with highest tumor-to-background ratios of 5.0 ± 1.3 at 72h using fluorescence and 4.2 ± 0.1 at 24h with radioactivity. 1-2 mm sized tumors could be clearly recognized by their fluorescent rim. This study showed the feasibility of an uPAR-recognizing multimodal agent to visualize tumors during image-guided resections using NIR fluorescence, whereas its nuclear component assisted in the pre-operative non-invasive recognition of tumors using SPECT imaging. This strategy can assist in surgical planning and subsequent precision surgery to reduce the number of incomplete resections.
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15
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Lippert S, Berg KD, Høyer-Hansen G, Lund IK, Iversen P, Christensen IJ, Brasso K, Røder MA. Copenhagen uPAR prostate cancer (CuPCa) database: protocol and early results. Biomark Med 2016; 10:209-16. [PMID: 26764285 DOI: 10.2217/bmm.15.114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AIM Urokinase plasminogen activator receptor (uPAR) plays a central role during cancer invasion by facilitating pericellular proteolysis. We initiated the prospective 'Copenhagen uPAR Prostate Cancer' study to investigate the significance of uPAR levels in prostate cancer (PCa) patients. METHODS Plasma samples and clinical data from patients with newly diagnosed PCa have been collected prospectively. The uPAR forms have been measured in plasma using time-resolved fluorescence immunoassays. RESULTS The level of intact uPAR(I-III) did not differ. Plasma uPAR(I-III) + uPAR(II-III) levels and uPAR(I) levels were significantly higher in hormone-naive and castrate-resistant patients compared with patients with localized disease (both: p < 0.0001). CONCLUSION Our results show that cleaved uPAR forms are significantly increased in patients with advanced PCa.
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Affiliation(s)
- Solvej Lippert
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kasper D Berg
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunilla Høyer-Hansen
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark.,Biotech Research & Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Ida K Lund
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark.,Biotech Research & Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Peter Iversen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ib J Christensen
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark.,Biotech Research & Innovation Centre (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Martin A Røder
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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16
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Tsuchiya N, Sawada Y, Endo I, Saito K, Uemura Y, Nakatsura T. Biomarkers for the early diagnosis of hepatocellular carcinoma. World J Gastroenterol 2015; 21:10573-10583. [PMID: 26457017 PMCID: PMC4588079 DOI: 10.3748/wjg.v21.i37.10573] [Citation(s) in RCA: 343] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/21/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related deaths worldwide. Although the prognosis of patients with HCC is generally poor, the 5-year survival rate is > 70% if patients are diagnosed at an early stage. However, early diagnosis of HCC is complicated by the coexistence of inflammation and cirrhosis. Thus, novel biomarkers for the early diagnosis of HCC are required. Currently, the diagnosis of HCC without pathological correlation is achieved by analyzing serum α-fetoprotein levels combined with imaging techniques. Advances in genomics and proteomics platforms and biomarker assay techniques over the last decade have resulted in the identification of numerous novel biomarkers and have improved the diagnosis of HCC. The most promising biomarkers, such as glypican-3, osteopontin, Golgi protein-73 and nucleic acids including microRNAs, are most likely to become clinically validated in the near future. These biomarkers are not only useful for early diagnosis of HCC, but also provide insight into the mechanisms driving oncogenesis. In addition, such molecular insight creates the basis for the development of potentially more effective treatment strategies. In this article, we provide an overview of the biomarkers that are currently used for the early diagnosis of HCC.
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17
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Full-length soluble urokinase plasminogen activator receptor down-modulates nephrin expression in podocytes. Sci Rep 2015; 5:13647. [PMID: 26380915 PMCID: PMC4585377 DOI: 10.1038/srep13647] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 08/03/2015] [Indexed: 12/25/2022] Open
Abstract
Increased plasma level of soluble urokinase-type plasminogen activator receptor (suPAR) was associated recently with focal segmental glomerulosclerosis (FSGS). In addition, different clinical studies observed increased concentration of suPAR in various glomerular diseases and in other human pathologies with nephrotic syndromes such as HIV and Hantavirus infection, diabetes and cardiovascular disorders. Here, we show that suPAR induces nephrin down-modulation in human podocytes. This phenomenon is mediated only by full-length suPAR, is time-and dose-dependent and is associated with the suppression of Wilms’ tumor 1 (WT-1) transcription factor expression. Moreover, an antagonist of αvβ3 integrin RGDfv blocked suPAR-induced suppression of nephrin. These in vitro data were confirmed in an in vivo uPAR knock out Plaur−/− mice model by demonstrating that the infusion of suPAR inhibits expression of nephrin and WT-1 in podocytes and induces proteinuria. This study unveiled that interaction of full-length suPAR with αvβ3 integrin expressed on podocytes results in down-modulation of nephrin that may affect kidney functionality in different human pathologies characterized by increased concentration of suPAR.
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18
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Erkut N, Menteşe A, Özbaş HM, Ermantaş N, Sümer A, Örem A, Sönmez M. The Prognostic Significance of Soluble Urokinase Plasminogen Activator Receptor in Acute Myeloid Leukemia. Turk J Haematol 2015; 33:135-40. [PMID: 26376588 PMCID: PMC5100725 DOI: 10.4274/tjh.2014.0405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: The soluble urokinase plasminogen activator receptor (suPAR) is a soluble form of the urokinase plasminogen activator receptor expressed in various immune and cancer cells. The levels of suPAR have been demonstrated to correlate with prognosis in various cancers. This study was intended to investigate serum suPAR levels and their effect on prognosis in patients with acute myeloid leukemia (AML). Materials and Methods: Thirty newly diagnosed patients with AML and 29 healthy individuals were enrolled. Serum suPAR levels were analyzed by enzyme-linked immunosorbent assay. Results: Serum suPAR levels were significantly higher in patients with AML than in healthy individuals (9±5.9 ng/mL and 2.4±1.4 ng/mL, respectively; p<0.001). Positive correlation was determined between suPAR levels and white blood cell counts (p<0.01). Serum suPAR levels were lower in patients who achieved complete response than in patients not achieving complete response (5.5±2.2 ng/mL and 12±6.6 ng/mL, respectively; p<0.001). The median overall survival was longer in patients with serum suPAR levels below 6.71 ng/mL than in those with serum suPAR levels above 6.71 ng/mL (12.6±13.2 months and 1.71±0.6 months, respectively; p=0.02). Multivariate Cox regression analysis showed that suPAR had independent prognostic value (95% confidence interval: 1.029-6.259; p<0.05) in AML. Conclusion: Serum suPAR levels can be used as a prognostic marker in AML.
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Affiliation(s)
- Nergiz Erkut
- Kanuni Training and Research Hospital, Clinic of Hematology, Trabzon, Turkey, Phone : +90 462 341 56 56 E-mail :
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19
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Gilder AS, Jones KA, Hu J, Wang L, Chen CC, Carter BS, Gonias SL. Soluble Urokinase Receptor Is Released Selectively by Glioblastoma Cells That Express Epidermal Growth Factor Receptor Variant III and Promotes Tumor Cell Migration and Invasion. J Biol Chem 2015; 290:14798-809. [PMID: 25837250 DOI: 10.1074/jbc.m115.637488] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Indexed: 12/13/2022] Open
Abstract
Genomic heterogeneity is characteristic of glioblastoma (GBM). In many GBMs, the EGF receptor gene (EGFR) is amplified and may be truncated to generate a constitutively active form of the receptor called EGFRvIII. EGFR gene amplification and EGFRvIII are associated with GBM progression, even when only a small fraction of the tumor cells express EGFRvIII. In this study, we show that EGFRvIII-positive GBM cells express significantly increased levels of cellular urokinase receptor (uPAR) and release increased amounts of soluble uPAR (suPAR). When mice were xenografted with human EGFRvIII-expressing GBM cells, tumor-derived suPAR was detected in the plasma, and the level was significantly increased compared with that detected in plasma samples from control mice xenografted with EGFRvIII-negative GBM cells. suPAR also was increased in plasma from patients with EGFRvIII-positive GBMs. Purified suPAR was biologically active when added to cultures of EGFRvIII-negative GBM cells, activating cell signaling and promoting cell migration and invasion. suPAR did not significantly stimulate cell signaling or migration of EGFRvIII-positive cells, probably because cell signaling was already substantially activated in these cells. The activities of suPAR were replicated by conditioned medium (CM) from EGFRvIII-positive GBM cells. When the CM was preincubated with uPAR-neutralizing antibody or when uPAR gene expression was silenced in cells used to prepare CM, the activity of the CM was significantly attenuated. These results suggest that suPAR may function as an important paracrine signaling factor in EGFRvIII-positive GBMs, inducing an aggressive phenotype in tumor cells that are EGFRvIII-negative.
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Affiliation(s)
| | | | | | - Lei Wang
- From the Departments of Pathology and
| | - Clark C Chen
- Surgery, Division of Neurosurgery, University of California at San Diego, La Jolla, California 92093
| | - Bob S Carter
- Surgery, Division of Neurosurgery, University of California at San Diego, La Jolla, California 92093
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20
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Thurison T, Almholt K, Gårdsvoll H, Ploug M, Høyer-Hansen G, Lund IK. Urokinase receptor cleavage correlates with tumor volume in a transgenic mouse model of breast cancer. Mol Carcinog 2015; 55:717-31. [DOI: 10.1002/mc.22316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/11/2015] [Accepted: 02/21/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Tine Thurison
- The Finsen Laboratory; Copenhagen University Hospital; Copenhagen Denmark
- Biotech Research & Innovation Centre (BRIC); University of Copenhagen; Copenhagen Denmark
| | - Kasper Almholt
- The Finsen Laboratory; Copenhagen University Hospital; Copenhagen Denmark
- Global Research; Novo Nordisk A/S; Måløv Denmark
| | - Henrik Gårdsvoll
- The Finsen Laboratory; Copenhagen University Hospital; Copenhagen Denmark
- Biotech Research & Innovation Centre (BRIC); University of Copenhagen; Copenhagen Denmark
| | - Michael Ploug
- The Finsen Laboratory; Copenhagen University Hospital; Copenhagen Denmark
- Biotech Research & Innovation Centre (BRIC); University of Copenhagen; Copenhagen Denmark
| | - Gunilla Høyer-Hansen
- The Finsen Laboratory; Copenhagen University Hospital; Copenhagen Denmark
- Biotech Research & Innovation Centre (BRIC); University of Copenhagen; Copenhagen Denmark
| | - Ida K. Lund
- The Finsen Laboratory; Copenhagen University Hospital; Copenhagen Denmark
- Biotech Research & Innovation Centre (BRIC); University of Copenhagen; Copenhagen Denmark
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21
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Tarpgaard LS, Christensen IJ, Høyer-Hansen G, Lund IK, Guren TK, Glimelius B, Sorbye H, Tveit KM, Nielsen HJ, Moreira JMA, Pfeiffer P, Brünner N. Intact and cleaved plasma soluble urokinase receptor in patients with metastatic colorectal cancer treated with oxaliplatin with or without cetuximab. Int J Cancer 2015; 137:2470-7. [PMID: 25664394 DOI: 10.1002/ijc.29476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/26/2015] [Indexed: 12/15/2022]
Abstract
Circulating forms of the urokinase plasminogen activator receptor (uPAR) are associated with prognosis in patients with colorectal cancer. Preclinical studies have shown that uPAR can influence the state of phosphorylation and signalling activity of the epidermal growth factor receptor (EGFR) in a ligand-independent manner. The purpose of the study was to evaluate whether plasma soluble intact and cleaved uPAR(I-III)+(II-III) levels could identify a subpopulation of patients with metastatic colorectal cancer (mCRC) where treatment with cetuximab would have a beneficial effect. Plasma samples were available from 453 patients treated in the NORDIC VII study. Patients were randomized between FLOX and FLOX + cetuximab. The levels of uPAR(I-III)+(II-III) were determined by time-resolved fluorescence immunoassay. We demonstrated that higher baseline plasma uPAR(I-III)+(II-III) levels were significantly associated with shorter progression-free survival (PFS) (HR = 1.30, 1.14-1.48, p = 0.0001) and overall survival (OS) (HR = 1.75, 1.52-2.02, p < 0.0001). Multivariate Cox analysis showed that plasma uPAR(I-III)+(II-III) was an independent biomarker of short OS (HR = 1.45, 1.20-1.75, p = 0.0001). There were no significant interactions between plasma uPAR(I-III)+(II-III) levels, KRAS mutational status and treatment either PFS (p = 0.43) or OS (p = 0.095). However, further explorative analyses indicated that patients with low levels of circulating suPAR and a KRAS wild-type tumor have improved effect from treatment with FLOX + cetuximab as compared to patients with KRAS wild-type and high levels of suPAR. These results thus support the preclinical findings and should be further tested in an independent clinical data set.
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Affiliation(s)
- Line S Tarpgaard
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ib J Christensen
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark.,Biotech Research and Innovation Center (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Gunilla Høyer-Hansen
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark.,Biotech Research and Innovation Center (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Ida K Lund
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark.,Biotech Research and Innovation Center (BRIC), University of Copenhagen, Copenhagen, Denmark
| | - Tormod K Guren
- Department of Oncology and K. G. Jebsen Centre for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Bengt Glimelius
- Department of Radiology, Uppsala University, Uppsala, Sweden.,Department of Oncology, Uppsala University, Uppsala, Sweden.,Department of Radiation Science, Uppsala University, Uppsala, Sweden.,Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Halfdan Sorbye
- Department of Oncology, Haukeland University Hospital, Bergen, Norway
| | - Kjell M Tveit
- Department of Oncology and K. G. Jebsen Centre for Colorectal Cancer Research, Oslo University Hospital, Oslo, Norway
| | - Hans Jørgen Nielsen
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Hvidovre, Denmark
| | - José M A Moreira
- Institute of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Per Pfeiffer
- Department of Oncology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Nils Brünner
- Institute of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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22
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Ahn SB, Chan C, Dent OF, Mohamedali A, Kwun SY, Clarke C, Fletcher J, Chapuis PH, Nice EC, Baker MS. Epithelial and stromal cell urokinase plasminogen activator receptor expression differentially correlates with survival in rectal cancer stages B and C patients. PLoS One 2015; 10:e0117786. [PMID: 25692297 PMCID: PMC4333212 DOI: 10.1371/journal.pone.0117786] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/31/2014] [Indexed: 12/24/2022] Open
Abstract
Urokinase plasminogen activator receptor (uPAR) has been proposed as a potential prognostic factor for colorectal cancer (CRC) patient survival. However, CRC uPAR expression remains controversial, especially regarding cell types where uPAR is overexpressed (e.g., epithelium (uPARE) or stroma-associated cells (uPARS)) and associated prognostic relevance. In this study, two epitope-specific anti-uPAR monoclonal antibodies (MAbs) could discriminate expression of uPARE from uPARS and were used to examine this association with survival of stages B and C rectal cancer (RC) patients. Using immunohistochemistry, MAbs #3937 and R4 were used to discriminate uPARE from uPARS respectively in the central and invasive frontal regions of 170 stage B and 179 stage C RC specimens. Kaplan-Meier and Cox regression analyses were used to determine association with survival. uPAR expression occurred in both epithelial and stromal compartments with differential expression observed in many cases, indicating uPARE and uPARS have different cellular roles. In the central and invasive frontal regions, uPARE was adversely associated with overall stage B survival (HR = 1.9; p = 0.014 and HR = 1.5; p = 0.031, respectively) reproducing results from previous studies. uPARS at the invasive front was associated with longer stage C survival (HR = 0.6; p = 0.007), reflecting studies demonstrating that macrophage peritumoural accumulation is associated with longer survival. This study demonstrates that different uPAR epitopes should be considered as being expressed on different cell types during tumour progression and at different stages in RC. Understanding how uPARE and uPARS expression affects survival is anticipated to be a useful clinical prognostic marker of stages B and C RC.
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Affiliation(s)
- Seong Beom Ahn
- Australian School of Advanced Medicine, Faculty of Human Science, Macquarie University, North Ryde, NSW 2109, Australia
| | - Charles Chan
- Anatomical Pathology Department, Concord Hospital and Discipline of Pathology, University of Sydney, Concord, NSW 2139, Australia
| | - Owen F Dent
- Department of Colorectal Surgery, Concord Hospital and Discipline of Surgery, University of Sydney, Concord, NSW 2139, Australia
| | - Abidali Mohamedali
- Australian School of Advanced Medicine, Faculty of Human Science, Macquarie University, North Ryde, NSW 2109, Australia
| | - Sun Young Kwun
- Anatomical Pathology Department, Concord Hospital and Discipline of Pathology, University of Sydney, Concord, NSW 2139, Australia
| | - Candice Clarke
- Anatomical Pathology Department, Concord Hospital and Discipline of Pathology, University of Sydney, Concord, NSW 2139, Australia
| | - Julie Fletcher
- Anatomical Pathology Department, Concord Hospital and Discipline of Pathology, University of Sydney, Concord, NSW 2139, Australia
| | - Pierre H Chapuis
- Department of Colorectal Surgery, Concord Hospital and Discipline of Surgery, University of Sydney, Concord, NSW 2139, Australia
| | - Edouard C Nice
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, VIC 3800, Australia
| | - Mark S Baker
- Australian School of Advanced Medicine, Faculty of Human Science, Macquarie University, North Ryde, NSW 2109, Australia
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Chounta A, Ellinas C, Tzanetakou V, Pliarhopoulou F, Mplani V, Oikonomou A, Leventogiannis K, Giamarellos-Bourboulis EJ. Serum soluble urokinase plasminogen activator receptor as a screening test for the early diagnosis of hepatocellular carcinoma. Liver Int 2015; 35:601-7. [PMID: 25348952 DOI: 10.1111/liv.12705] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 10/17/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Early detection of hepatocellular carcinoma (HCC) before imaging signs appear remains an unmet medical need. Former publications suggest that soluble urokinase plasminogen activator receptor (suPAR) is a non-specific cancer marker. suPAR was validated for the detection of patients at risk for HCC. METHODS After an initial training set in 23 patients with extreme disease phenotypes, a prospective test set was conducted in which 267 patients without any imaging signs of HCC were followed up for 7 years. Patients were divided into low risk and high risk for the development of HCC by the EASL criteria. suPAR was measured at the beginning of follow-up. All patients underwent liver biopsy to define staging of fibrosis. The primary study endpoint was to define a cut-off among high-risk patients by the EASL criteria that can early discriminate those at real risk for HCC. RESULTS The training set showed that suPAR was significantly greater in patients with HCC even in the absence of underlying cirrhosis compared with patients with minimal liver inflammation because of fatty deposition. The test set showed that among the high-risk EASL subgroup, suPAR more than 9.56 ng/ml had sensitivity 76.0%, specificity 90.4%, positive predictive value 54.3% and negative predictive value 96.2% for the development of HCC (odds ratio: 29.88, P < 0.0001). In survival analysis, patients with suPAR above 9.56 ng/ml at baseline progressed earlier to HCC. CONCLUSIONS The specificity and negative predictive value make serum suPAR a potential screening tool for the early detection of HCC in patients with chronic liver disorders.
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Affiliation(s)
- Athina Chounta
- 4th Department of Internal Medicine, University of Athens, Medical School, Athens, Greece
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24
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Nagaraju GP, Long TE, Park W, Landry JC, Taliaferro-Smith L, Farris AB, Diaz R, El-Rayes BF. Heat shock protein 90 promotes epithelial to mesenchymal transition, invasion, and migration in colorectal cancer. Mol Carcinog 2014; 54:1147-58. [PMID: 24861206 DOI: 10.1002/mc.22185] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 04/19/2014] [Accepted: 05/05/2014] [Indexed: 12/11/2022]
Abstract
Epithelial to mesenchymal transition (EMT), invasion, and motility are essential steps in colorectal cancer (CRC) metastasis regulated by HIF-1α and NF-κB. Since HSP90 activates HIF-1α and NF-κB, we hypothesized that inhibition of HSP90 leads to inhibition of HIF-1α and NF-κB resulting in inhibition of EMT, invasion, and motility. Treatment of colorectal cancer cell lines HT-29 and HCT-116 with ganetespib at 50 nM for 24 h inhibited EMT (downregulated vimentin and upregulated E-cadherin), matrigel invasion, and spheroid migration. Ganetespib treatment or HSP90 knockdown downregulated molecular pathways associated with EMT, invasion, and motility. The overexpression of HIF-1α or NF-κB resulted in increased EMT, invasion, and motility in both cell lines and these effects were inhibited by ganetespib. Similar effects were observed in animal xenografts treated with ganetespib. Taken together, our data demonstrate for the first time that inhibition of HSP90 downregulates both HIF-1α and NF-κB leading to inhibition of EMT, motility, and invasiveness in colorectal cancer.
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Affiliation(s)
- Ganji Purnachandra Nagaraju
- Department of Hematology Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.,School of Medicine, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Tua-Elisabeth Long
- School of Medicine, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Wungki Park
- School of Medicine, Winship Cancer Institute, Emory University, Atlanta, Georgia.,Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Jerome C Landry
- School of Medicine, Winship Cancer Institute, Emory University, Atlanta, Georgia.,Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - LaTonia Taliaferro-Smith
- Department of Hematology Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.,School of Medicine, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Alton B Farris
- Department of Pathology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Roberto Diaz
- School of Medicine, Winship Cancer Institute, Emory University, Atlanta, Georgia.,Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Bassel F El-Rayes
- Department of Hematology Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.,School of Medicine, Winship Cancer Institute, Emory University, Atlanta, Georgia
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25
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Prognostic significance of circulating intact and cleaved forms of urokinase plasminogen activator receptor in inoperable chemotherapy treated cholangiocarcinoma patients. Clin Biochem 2014; 47:599-604. [DOI: 10.1016/j.clinbiochem.2014.01.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/28/2014] [Accepted: 01/29/2014] [Indexed: 02/07/2023]
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26
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Boonstra MC, Verbeek FPR, Mazar AP, Prevoo HAJM, Kuppen PJK, van de Velde CJH, Vahrmeijer AL, Sier CFM. Expression of uPAR in tumor-associated stromal cells is associated with colorectal cancer patient prognosis: a TMA study. BMC Cancer 2014; 14:269. [PMID: 24742002 PMCID: PMC3997436 DOI: 10.1186/1471-2407-14-269] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 04/03/2014] [Indexed: 01/22/2023] Open
Abstract
Background The receptor for urokinase-type plasminogen activator (uPAR) is associated with cancer development and progression. Within the tumor microenvironment uPAR is expressed by malignant cells as well as tumor-associated stromal cells. However, the contribution of uPAR expression in these stromal cells to malignancy and patient survival in colorectal cancer is still unclear. This study compares the association of uPAR expression in both colorectal tumor-associated stromal cells and neoplastic cells with clinico-pathological characteristics and patient survival using tissue micro arrays (TMA). Methods Immunohistochemical staining of uPAR expression was performed on tumor tissue from 262 colorectal cancer patients. Kaplan-Meier, log rank, and uni- and multivariate Cox’s regression analyses were used to calculate associations between uPAR expression and patient survival. Results In the colorectal tumor-associated stromal microenvironment, uPAR is expressed in macrophages, (neoangiogenic) endothelial cells and myofibroblasts. uPAR expression in tumor-associated stromal cells and neoplastic cells (and both combined) were negatively associated with overall survival (OS) and Disease Free Survival (DFS). Uni- and multivariate Cox’s regression analysis for combined uPAR expression in tumor-associated stromal and neoplastic cells showed significant and independent negative associations with OS and DFS. Only uPAR expression in tumor-associated stromal cells showed independent significance in the uni- and multivariate analysis for DFS. Conclusion This study demonstrates a significant independent negative association between colorectal cancer patient survival and uPAR expression in especially tumor-associated stromal cells.
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Affiliation(s)
| | | | | | | | | | | | | | - Cornelis F M Sier
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
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27
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Persson M, El Ali HH, Binderup T, Pfeifer A, Madsen J, Rasmussen P, Kjaer A. Dosimetry of 64Cu-DOTA-AE105, a PET tracer for uPAR imaging. Nucl Med Biol 2014; 41:290-5. [DOI: 10.1016/j.nucmedbio.2013.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 11/28/2013] [Accepted: 12/07/2013] [Indexed: 01/08/2023]
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28
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Engelmann BE, Loft A, Kjær A, Nielsen HJ, Berthelsen AK, Binderup T, Brinch K, Brünner N, Gerds TA, Høyer-Hansen G, Kristensen MH, Kurt EY, Latocha JE, Lindblom G, Sloth C, Højgaard L. Positron emission tomography/computed tomography for optimized colon cancer staging and follow up. Scand J Gastroenterol 2014; 49:191-201. [PMID: 24286594 PMCID: PMC3956490 DOI: 10.3109/00365521.2013.863967] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Optimal management of colon cancer (CC) requires detailed assessment of extent of disease. This study prospectively investigates the diagnostic accuracy of 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography (PET/CT) for staging and detection of recurrence in primary CC. MATERIAL AND METHODS PET/CT for preoperative staging was performed in 66 prospectively included patients with primary CC. Diagnostic accuracy for PET/CT and CT was analyzed. In addition to routine follow up, 42 stages I-III CC patients had postoperative PET/CT examinations every 6 months for 2 years. Serological levels of tissue inhibitor of metalloproteinase-1 (TIMP-1), carcinoembryonic antigen, and liberated domain I of urokinase plasminogen activator receptor were analyzed. RESULTS Accuracy for tumor, nodal, and metastases staging by PET/CT were 82% (95% confidence interval [CI]: 70; 91), 66% (CI: 51; 78), and 89% (CI: 79; 96); for CT the accuracy was 77% (CI: 64; 87), 60% (CI: 46; 73), and 69% (CI: 57; 80). Cumulative relapse incidences for stages I-III CC at 6, 12, 18, and 24 months were 7.1% (CI: 0; 15); 14.3% (CI: 4; 25); 19% (CI: 7; 31), and 21.4% (CI: 9; 34). PET/CT diagnosed all relapses detected during the first 2 years. High preoperative TIMP-1 levels were associated with significant hazards toward risk of recurrence and shorter overall survival. CONCLUSIONS This study indicates PET/CT as a valuable tool for staging and follow up in CC. TIMP-1 provided prognostic information potentially useful in selection of patients for intensive follow up.
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Affiliation(s)
- Bodil Elisabeth Engelmann
- Department of Clinical Physiology and Nuclear Medicine, Næstved Hospital, Næstved, Denmark,Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark,Cluster for Molecular Imaging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hans Jørgen Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Copenhagen, Denmark
| | - Anne Kiil Berthelsen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Tina Binderup
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark,Cluster for Molecular Imaging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Brinch
- Department of Clinical Physiology and Nuclear Medicine, Næstved Hospital, Næstved, Denmark
| | - Nils Brünner
- Institute of Veterinary Disease Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | | | - Gunilla Høyer-Hansen
- The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark and Biotech Research and Innovation Center (BRIC), University of Copenhagen, Copenhagen, Denmark,Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | | | - Engin Yeter Kurt
- Department of Radiology, Rigshospitalet Copenhagen University Hospital, Denmark
| | | | - Gunnar Lindblom
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Carsten Sloth
- Department of Radiology, Næstved Hospital, Næstved, Denmark
| | - Liselotte Højgaard
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
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29
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Engelmann BE, Loft A, Kjær A, Nielsen HJ, Gerds TA, Benzon EV, Brünner N, Christensen IJ, Hansson SH, Holländer NH, Kristensen MH, Löfgren J, Markova E, Sloth C, Højgaard L. Positron emission tomography/computed tomography and biomarkers for early treatment response evaluation in metastatic colon cancer. Oncologist 2014; 19:164-72. [PMID: 24451199 DOI: 10.1634/theoncologist.2013-0229] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Treatment options for metastatic colon cancer (mCC) are widening. We prospectively evaluated serial 2-deoxy-2-[18F]fluoro-d-glucose positron-emission tomography/computed tomography (PET/CT) and measurements of tissue inhibitor of metalloproteinases-1 (TIMP-1), carcinoembryonic antigen (CEA), and liberated domain I of urokinase plasminogen activator receptor (uPAR(I)) for early assessment of treatment response in mCC patients. METHODS Thirty-three mCC patients scheduled for first-line chemotherapy with capecitabine and oxaliplatin (CAPOX) and bevacizumab participated; 27 were evaluated by PET/CT before treatment, after one and four treatment series. Morphological and metabolic response was independently assessed according to Response Evaluation Criteria in Solid Tumors and European Organization for Research and Treatment of Cancer PET criteria. Plasma TIMP-1, plasma uPAR(I), and serum CEA were determined. RESULTS Metabolic response after one treatment course predicted the ability of CAPOX and bevacizumab to induce morphological response after four treatment series with a sensitivity of 80%, specificity of 69%, and odds ratio of 13.9 (95% confidence interval [CI] 1.9; 182). Early metabolically stable or progressive disease was associated with shorter progression-free survival (hazard ratio [HR] = 3.2 [CI 1.3; 7.8]). Biomarker levels at early evaluation were associated with shorter OS (TIMP-1 per unit increase on a log-2-transformed ng/mL scale: HR = 2.6 [CI 1.4; 4.9]; uPAR(I) per 25 fmol/mL increase: HR = 1.5 [CI 1.1; 2.1]). CONCLUSION This monocentric study demonstrated predictive value of early metabolic PET response and prognostic value of TIMP-1 and uPAR(I) levels in mCC treated with CAPOX and bevacizumab. Results support investigation of PET/CT, TIMP-1, and uPAR(I) guided early treatment adaptation in mCC.
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Affiliation(s)
- Bodil E Engelmann
- Departments of Clinical Physiology and Nuclear Medicine, Hematology and Oncology, Clinical Pathology, and Radiology, Næstved Hospital, Næstved, Denmark; Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark; Department of Public Health, Core Biostatistics, University of Copenhagen, Copenhagen, Denmark; Institute of Veterinary Disease Biology, University of Copenhagen, Frederiksberg, Denmark; Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark, and Biotech Research and Innovation Center, University of Copenhagen, Copenhagen, Denmark
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30
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Mengele K, Napieralski R, Magdolen V, Reuning U, Gkazepis A, Sweep F, Brünner N, Foekens J, Harbeck N, Schmitt M. Characteristics of the level-of-evidence-1 disease forecast cancer biomarkers uPA and its inhibitor PAI-1. Expert Rev Mol Diagn 2014; 10:947-62. [DOI: 10.1586/erm.10.73] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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31
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Taubert H, Magdolen V, Kotzsch M. Impact of expression of the uPA system in sarcomas. Biomark Med 2013; 7:473-80. [PMID: 23734810 DOI: 10.2217/bmm.12.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The uPA system mainly comprises the urokinase-type plasminogen activator uPA, the cell-surface receptor uPA receptor and the inhibitor PAI-1. Its clinical and prognostic impact especially in breast cancer is well investigated. In this short report, we summarize the published data describing expression of uPA, PAI-1 and uPA receptor and their relevance to clinical and survival data in sarcomas underlining their impact as tumor biomarkers in this tumor type as well.
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Affiliation(s)
- Helge Taubert
- Clinic of Urology, Division of Molecular Urology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
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32
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Nebuloni M, Zawada L, Ferri A, Tosoni A, Zerbi P, Resnati M, Poli G, Genovese L, Alfano M. HIV-1 infected lymphoid organs upregulate expression and release of the cleaved form of uPAR that modulates chemotaxis and virus expression. PLoS One 2013; 8:e70606. [PMID: 23923008 PMCID: PMC3726662 DOI: 10.1371/journal.pone.0070606] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/21/2013] [Indexed: 11/18/2022] Open
Abstract
Cell-associated receptor for urokinase plasminogen activator (uPAR) is released as both full-length soluble uPAR (suPAR) and cleaved (c-suPAR) form that maintain ability to bind to integrins and other receptors, thus triggering and modulating cell signaling responses. Concerning HIV-1 infection, plasma levels of suPAR have been correlated with the severity of disease, levels of immune activation and ineffective immune recovery also in individuals receiving combination anti-retroviral therapy (cART). However, it is unknown whether and which suPAR forms might contribute to HIV-1 induced pathogenesis and to the related state of immune activation. In this regard, lymphoid organs represent an import site of chronic immune activation and virus persistence even in individuals receiving cART. Lymphoid organs of HIV-1(+) individuals showed an enhanced number of follicular dendritic cells, macrophages and endothelial cells expressing the cell-associated uPAR in comparison to those of uninfected individuals. In order to investigate the potential role of suPAR forms in HIV-1 infection of secondary lymphoid organs, tonsil histocultures were established from HIV-1 seronegative individuals and infected ex vivo with CCR5- and CXCR4-dependent HIV-1 strains. The levels of suPAR and c-suPAR were significantly increased in HIV-infected tonsil histocultures supernatants in comparison to autologous uninfected histocultures. Supernatants from infected and uninfected cultures before and after immunodepletion of suPAR forms were incubated with the chronically infected promonocytic U1 cell line characterized by a state of proviral latency in unstimulated conditions. In the contest of HIV-conditioned supernatants we established that c-suPAR, but not suPAR, inhibited chemotaxis and induced virus expression in U1 cells. In conclusion, lymphoid organs are an important site of production and release of both suPAR and c-suPAR, this latter form being endowed with the capacity of inhibiting chemotaxis and inducing HIV-1 expression.
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Affiliation(s)
- Manuela Nebuloni
- Pathology Unit, “Luigi Sacco” Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Lidia Zawada
- Pathology Unit, “Luigi Sacco” Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Angelita Ferri
- Pathology Unit, “Luigi Sacco” Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Antonella Tosoni
- Pathology Unit, “Luigi Sacco” Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Pietro Zerbi
- Pathology Unit, “Luigi Sacco” Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Massimo Resnati
- Molecular Genetic Unit, Division of Genetics and Cell Biology, San Raffaele Scientific Institute, Milan, Italy
| | - Guido Poli
- Vita-Salute San Raffaele University, School of Medicine, Milan, Italy
- AIDS Immunopathogenesis Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Genovese
- AIDS Immunopathogenesis Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Alfano
- AIDS Immunopathogenesis Unit, Division of Immunology, Transplantation and Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
- * E-mail:
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33
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Persson M, Kjaer A. Urokinase-type plasminogen activator receptor (uPAR) as a promising new imaging target: potential clinical applications. Clin Physiol Funct Imaging 2013; 33:329-37. [PMID: 23701192 PMCID: PMC3799014 DOI: 10.1111/cpf.12037] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 02/04/2013] [Indexed: 01/15/2023]
Abstract
Urokinase-type plasminogen activator receptor (uPAR) has been shown to be of special importance during cancer invasion and metastasis. However, currently, tissue samples are needed for measurement of uPAR expression limiting the potential as a clinical routine. Therefore, non-invasive methods are needed. In line with this, uPAR has recently been identified as a very promising imaging target candidate. uPAR consists of three domains attached to the cell membrane via a glycosylphosphatidylinositol (GPI) anchor and binds it natural ligand uPA with high affinity to localize plasminogen activation at the cell surface. Due to the importance of uPAR in cancer invasion and metastasis, a number of high-affinity ligands have been identified during the last decades. These ligands have recently been used as starting point for the development of a number of ligands for imaging of uPAR using various imaging modalities such as optical imaging, magnetic resonance imaging, single photon emission computer tomography (SPECT) and positron emission topography (PET). In this review, we will discuss recent advances in the development of uPAR-targeted imaging ligands according to imaging modality. In addition, we will discuss the potential future clinical application for uPAR imaging as a new imaging biomarker.
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Affiliation(s)
- Morten Persson
- Department of Clinical Physiology, Nuclear Medicine and PET, Center for Diagnostic Investigations, Rigshospitalet, Copenhagen, Denmark
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34
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Odden N, Henriksen T, Mørkrid L. Serum soluble urokinase plasminogen activator receptor (suPAR) in early pregnancy prior to clinical onset of preeclampsia. Acta Obstet Gynecol Scand 2012; 91:1226-32. [PMID: 22774918 DOI: 10.1111/j.1600-0412.2012.01504.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine whether soluble urokinase plasminogen activator receptor (suPAR) in early pregnancy could be a risk marker for later development of preeclampsia. DESIGN Case-control study. SETTING Hospital-based. POPULATION The study comprised 43 pregnant women developing preeclampsia (cases) and 86 pregnant women not developing the disorder (controls). Each case was matched with two controls with respect to pre-pregnancy body mass index, gestational age at time of blood collection, storage time of blood samples and maternal age. METHODS The samples had been taken predominantly in the first trimester as part of a routine serological screening for rubella, HIV and toxoplasmosis of Norwegian pregnant women, and were analyzed by a commercially available enzyme-linked immunosorbent suPARnostic® assay kit (ELISA, Virogates, Copenhagen, Denmark). RESULTS There was no significant difference between median suPAR levels in women who subsequently developed preeclampsia and those who did not (4.5 in the case group vs. 4.3 ng/mL in the control group, p= 0.49). The suPAR levels were relatively high compared with levels in non-pregnant women, reflecting some general physiological responsiveness associated with pregnancy irrespective of preeclampsia. The suPAR level was not related to maternal body mass index, maternal age or sample storage time, nor did it show any association with the following fetal characteristics: body weight, body length, placental weight, delivery method or gender. CONCLUSION suPAR did not appear to be a useful early pre-clinical marker of preeclampsia.
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Affiliation(s)
- Nancy Odden
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.
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35
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Persson M, Rasmussen P, Madsen J, Ploug M, Kjaer A. New peptide receptor radionuclide therapy of invasive cancer cells: in vivo studies using 177Lu-DOTA-AE105 targeting uPAR in human colorectal cancer xenografts. Nucl Med Biol 2012; 39:962-9. [PMID: 22739362 DOI: 10.1016/j.nucmedbio.2012.05.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 05/09/2012] [Accepted: 05/19/2012] [Indexed: 02/08/2023]
Abstract
UNLABELLED The proposition of uPAR as a potential target in cancer therapy is advanced by its predominant expression at the invasive front of colorectal cancer (CRC) and its value as prognostic biomarker for poor survival in this disease. In this study, we provide the first in vivo proof-of-concept for a theranostic approach as treatment modality in a human xenograft colorectal cancer model. METHODS A DOTA-conjugated 9-mer high affinity uPAR binding peptide (DOTA-AE105) was radiolabeled with (64)Cu and (177)Lu, for PET imaging and targeted radionuclide therapy study, respectively. Human uPAR-positive CRC HT-29 cells were inoculated in Nude mice and treated with (177)Lu-DOTA-AE105 once a visible tumor had formed. To evaluate the true effect of the targeted radiotherapy, two controls groups were included in this study, one receiving a (177)Lu-labeled non-binding control peptide and one receiving vehicle. All animals were treated day 0 and 7. A parallel (18)F-FLT PET/CT study was performed on day 0, 1, 3 and 6. Dosimetry calculations were based on a biodistribution study, where organs and tissue of interest were collected 0.5, 1.0, 2.0, 4.0 and 24h post injection of (177)Lu-DOTA-AE105. Toxicity was assessed by recording mouse weight and by H&E staining of kidneys in each treatment group. RESULTS uPAR-positive HT-29 xenograft was clearly visualized by PET/CT imaging using (64)Cu-DOTA-AE105. Subsequently, these xenograft transplants were locally irradiated using (177)Lu-DOTA-AE105, where a significant effect on tumor size and the number of uPAR-positive cells in the tumor was found (p<0.05). Evaluations of biodistribution and dosimetry revealed highest accumulation of radioactivity in kidneys and tumor tissue. (18)F-FLT PET/CT imaging study revealed a significant correlation between (18)F-FLT tumor uptake and efficacy of the radionuclide therapy. A histological examination of the kidneys from one animal in each treatment group did not reveal any gross abnormalities and the general performance of all treated animals also showed no indications of radioactivity-induced toxicity. CONCLUSION These findings document for the first time the in vivo efficacy of an uPAR-targeted radionuclide therapeutic intervention on both tumor size and its content of uPAR expressing cells thus setting the stage for future translation into clinical use.
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Affiliation(s)
- Morten Persson
- The Danish-Chinese Center for Proteases and Cancer, Center for Diagnostic Investigations, Rigshospitalet, Copenhagen, Denmark
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Nielsen HJ, Jakobsen KV, Christensen IJ, Brünner N. Screening for colorectal cancer: possible improvements by risk assessment evaluation? Scand J Gastroenterol 2011; 46:1283-94. [PMID: 21854094 PMCID: PMC3205805 DOI: 10.3109/00365521.2011.610002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 06/24/2011] [Accepted: 07/07/2011] [Indexed: 02/06/2023]
Abstract
Emerging results indicate that screening improves survival of patients with colorectal cancer. Therefore, screening programs are already implemented or are being considered for implementation in Asia, Europe and North America. At present, a great variety of screening methods are available including colono- and sigmoidoscopy, CT- and MR-colonography, capsule endoscopy, DNA and occult blood in feces, and so on. The pros and cons of the various tests, including economic issues, are debated. Although a plethora of evaluated and validated tests even with high specificities and reasonable sensitivities are available, an international consensus on screening procedures is still not established. The rather limited compliance in present screening procedures is a significant drawback. Furthermore, some of the procedures are costly and, therefore, selection methods for these procedures are needed. Current research into improvements of screening for colorectal cancer includes blood-based biological markers, such as proteins, DNA and RNA in combination with various demographically and clinically parameters into a "risk assessment evaluation" (RAE) test. It is assumed that such a test may lead to higher acceptance among the screening populations, and thereby improve the compliances. Furthermore, the involvement of the media, including social media, may add even more individuals to the screening programs. Implementation of validated RAE and progressively improved screening methods may reform the cost/benefit of screening procedures for colorectal cancer. Therefore, results of present research, validating RAE tests, are awaited with interest.
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Affiliation(s)
- Hans J Nielsen
- Department of Surgical Gastroenterology, Hvidovre Hospital, Hvidovre, Denmark.
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Laerum OD, Ovrebo K, Skarstein A, Christensen IJ, Alpízar-Alpízar W, Helgeland L, Danø K, Nielsen BS, Illemann M. Prognosis in adenocarcinomas of lower oesophagus, gastro-oesophageal junction and cardia evaluated by uPAR-immunohistochemistry. Int J Cancer 2011; 131:558-69. [PMID: 21866548 DOI: 10.1002/ijc.26382] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 07/21/2011] [Indexed: 12/14/2022]
Abstract
Adenocarcinomas of lower oesophagus, gastro-oesophageal junction and cardia in humans are highly invasive tumours with poor prognosis. The localisation of urokinase-type plasminogen activator receptor (uPAR) was determined in 66 patients; 60 with adenocarcinomas and six cases with Barrett's oesophagus. uPAR was expressed in nearly all cases of invasive adenocarcinomas by populations of cancer cells, macrophages and myofibroblasts at both the invasion front and the tumour core. In areas with high-grade dysplasia or with Barrett's metaplasia adjacent to the tumour tissue, no uPAR-immunoreactivity was found. High local expression of uPAR, therefore, appears to be a characteristic marker for invasive behaviour in this tumour, suggesting that uPAR's contribution to matrix degradation during invasive growth is a late event in carcinogenesis. Using a scoring system for semiquantitative estimation of uPAR-positivity on immmunohistochemically stained specimens, a significant association was found between poor overall survival and high uPAR-score for cancer cells in the tumour core and for macrophages peripherally at the tumour invasion zone. In multivariate analysis, these two uPAR-scores were confirmed as highly significant prognostic parameters independent of Tumour, Node, Metastasis (TNM)-stage and World Health Organization (WHO) classification. The proteolytic action of these malignant and nonmalignant accessory cells thus seemed to follow two main patterns: one dominated by uPAR positive cancer cells and one by uPAR-positive macrophages. Scoring of uPAR-positivity might be a useful parameter for onset of invasion and prognosis in these adenocarcinomas.
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Affiliation(s)
- Ole Didrik Laerum
- The Finsen Laboratory, Copenhagen University Hospital, Copenhagen, Denmark.
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Tzanakaki G, Paparoupa M, Kyprianou M, Barbouni A, Eugen-Olsen J, Kourea-Kremastinou J. Elevated soluble urokinase receptor values in CSF, age and bacterial meningitis infection are independent and additive risk factors of fatal outcome. Eur J Clin Microbiol Infect Dis 2011; 31:1157-62. [DOI: 10.1007/s10096-011-1423-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 09/12/2011] [Indexed: 10/17/2022]
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Elevated soluble urokinase plasminogen activator receptor (suPAR) predicts mortality in Staphylococcus aureus bacteremia. Eur J Clin Microbiol Infect Dis 2011; 30:1417-24. [PMID: 21479972 DOI: 10.1007/s10096-011-1236-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 03/20/2011] [Indexed: 10/17/2022]
Abstract
The soluble form of urokinase-type plasminogen activator receptor (suPAR) is a new inflammatory marker. High suPAR levels have been shown to associate with mortality in cancer and in chronic infections like HIV and tuberculosis, but reports on the role of suPAR in acute bacteremic infections are scarce. To elucidate the role of suPAR in a common bacteremic infection, the serum suPAR levels in 59 patients with Staphylococcus aureus bacteremia (SAB) were measured using the suPARnostic ELISA assay and associations to 1-month mortality and with deep infection focus were analyzed. On day three, after the first positive blood culture for S. aureus, suPAR levels were higher in 19 fatalities (median 12.3; range 5.7-64.6 ng/mL) than in 40 survivors (median 8.4; range 3.7-17.6 ng/mL, p = 0.002). This difference persisted for 10 days. The presence of deep infection focus was not associated with elevated suPAR levels as compared to patients with no deep infection focus. suPAR was found to be prognostic for mortality in receiver operator characteristic (ROC) curve analysis, which was not observed for serum C-reactive protein (CRP); the area under the curve (AUC) for suPAR was 0.754 (95% confidence interval [CI], 0.615-0.894, p = 0.003) and for CRP, it was 0.596 (95% CI, 0.442-0.750, p = 0.253). The optimal suPAR cut-off value in predicting 1-month mortality was 9.25 ng/mL. In conclusion, our study demonstrates that the new promising biomarker, serum suPAR concentration, was able to predict mortality in SAB.
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Lönnkvist MH, Theodorsson E, Holst M, Ljung T, Hellström PM. Blood chemistry markers for evaluation of inflammatory activity in Crohn's disease during infliximab therapy. Scand J Gastroenterol 2011; 46:420-7. [PMID: 21114432 DOI: 10.3109/00365521.2010.539253] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE There is a discrepancy between clinical activity and biomarkers in inflammatory bowel disease. The Harvey-Bradshaw index (HBi) is steadfast to evaluate disease activity. A set of biological markers (high sensitive C-reactive protein [hs-CRP], calprotectin, total nitrite, soluble urokinase Plasminogen Activator Receptor [suPAR], ghrelin and endothelin) are investigated to study inflammatory activity and correlation with HBi during infliximab therapy. MATERIAL AND METHODS Patients with Crohn's disease (n = 22) were assessed and blood samples drawn before and 1 week after infliximab infusion (5 mg/kg) and repeated after 6 months, and compared to healthy volunteers. Hs-CRP, calprotectin, suPAR, ghrelin and endothelin were analyzed with immunoassays, and total nitrite with Griess-reaction. Results were analyzed with Wilcoxon matched-pairs test, Mann-Whitney test and Spearman correlations. RESULTS After the first infusion visit, HBi and calprotectin values decreased while nitrite increased (p < 0.05). At the 6-month visit, pre-infusion index and biomarkers had returned to baseline levels. Post-infusion, again the values of HBi, hs-CRP and calprotectin decreased (p < 0.05). The suPAR levels did not change between pre- and post-infusion periods at either visit. Calprotectin, nitrite and suPAR differed from healthy controls throughout the study (p < 0.05). Endothelin decreased with each treatment but was, like ghrelin, not different from controls. We found HBi to correlate with hs-CRP (Spearman r = 0.32, p < 0.05), but calprotectin did not, neither did nitrate nor suPAR. CONCLUSIONS Although infliximab ameliorates Crohn's disease symptoms, inflammatory markers are not persistently normalized, indicating a chronic inflammatory condition that may require continued infliximab therapy.
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Affiliation(s)
- Maria H Lönnkvist
- Department of Medicine, Gastroenterology and Hepatology Unit, Karolinska University Hospital Solna, Sweden
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