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Measurement of serum suPAR is not ready for clinical use

Nature Reviews Nephrology volume 10, page 610 (2014)Cite this article

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We thank Howard Trachtman and Jochen Reiser for their comment (suPAR is the circulating factor in some but not all FSGS. Nat. Rev. Nephrol. 26 August 2014; doi:10.1038/nrneph.2014.113-c1)1 on our News & Views commentary (The search goes on: suPAR is not the elusive FSGS factor. Nat. Rev. Nephrol. 10, 431–432; 2014).2 Trachtman and Reiser use the football World Cup as a metaphor for scientific research. In this respect, we wonder what is a goal? For scientists a high-impact publication or grant approval might be considered a goal, whereas for clinicians and patients the score is opened if research leads to direct patient benefit. Currently the Tour de France is receiving attention. We feel that patient-centred research is best compared with a team time trial in a mountainous region; close collaboration is needed and each member takes the lead for shorter or longer time periods. Moreover, when the top of a mountain is reached the view is spectacular, but new peaks are visible on the horizon and the finish remains out of sight.

Reiser and his group have performed important experimental studies in mice and podocytes that have provided evidence for a possible role of soluble urokinase plasminogen activator receptor (suPAR) in focal segmental glomerulosclerosis (FSGS).3 However, when writing a commentary on new data,2 we believe that it is our task as clinicians and clinical researchers to judge if scientific findings can be directly applied to the patients we look after. In their study, Reiser and colleagues validated their findings in patients with FSGS.3 Based on these results, many patients and physicians thought that measurement of suPAR could immediately be applied in patient care. Unfortunately, the study included a heterogeneous population with poorly phenotyped patients and a lack of appropriate controls. Indeed, recent clinical studies showed that when adjusted for estimated glomerular filtration rate (eGFR), levels of intact suPAR do not differentiate between patients with idiopathic FSGS and those with secondary FSGS, or between patients with FSGS, other glomerular diseases or chronic kidney disease.4,5,6,7,8 In our commentary we concluded that no role exists for the measurement of intact suPAR levels in patients with FSGS. Unglycosylated suPAR or suPAR fragments remain important candidates for the circulating permeability factor in this disease, but further studies are needed to provide proof of concept.

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References

  1. Trachtman, H. & Reiser, J. suPAR is the circulating factor in some but not all FSGS. Nat. Rev. Nephrol. http://dx.doi.org/10.1038/nrneph.2014.113-c1.

  2. Deegens, J. K. & Wetzels, J. F. The search goes on: suPAR is not the elusive FSGS factor. Nat. Rev. Nephrol. 10, 431–432 (2014).

    Article  CAS  Google Scholar 

  3. Wei, C. et al. Circulating urokinase receptor as a cause of focal segmental glomerulosclerosis. Nat. Med. 17, 952–960 (2011).

    Article  CAS  Google Scholar 

  4. Meijers, B. et al. The soluble urokinase receptor is not a clinical marker for focal segmental glomerulosclerosis. Kidney Int. 85, 636–640 (2014).

    Article  CAS  Google Scholar 

  5. Bock, M. E., Price, H. E., Gallon, L. & Langman, C. B. Serum soluble urokinase-type plasminogen activator receptor levels and idiopathic FSGS in children: a single-center report. Clin. J. Am. Soc. Nephrol. 8, 1304–1311 (2013).

    Article  CAS  Google Scholar 

  6. Sinha, A. et al. Serum-soluble urokinase receptor levels do not distinguish focal segmental glomerulosclerosis from other causes of nephrotic syndrome in children. Kidney Int. 85, 649–658 (2014).

    Article  CAS  Google Scholar 

  7. Wada, T. et al. A multicenter cross-sectional study of circulating soluble urokinase receptor in Japanese patients with glomerular disease. Kidney Int. 85, 641–648 (2014).

    Article  CAS  Google Scholar 

  8. Maas, R. J., Wetzels, J. F. & Deegens, J. K. Serum-soluble urokinase receptor concentration in primary FSGS. Kidney Int. 81, 1043–1044 (2012).

    Article  CAS  Google Scholar 

  9. Alachkar, N. et al. Podocyte effacement closely links to suPAR levels at time of posttransplantation focal segmental glomerulosclerosis occurrence and improves with therapy. Transplantation 96, 649–656 (2013).

    Article  CAS  Google Scholar 

  10. Yoo, T. H. et al. Sphingomyelinase-like phosphodiesterase 3b expression levels determine podocyte injury phenotypes in glomerular disease. J. Am. Soc. Nephrol. http://dx.doi.org/10.1681/ASN.2013111213.

  11. Theilade, S. et al. Soluble urokinase plasminogen activator receptor levels are elevated and associated with complications in patients with type 1 diabetes. J. Intern. Med. http://dx.doi.org/10.1111/joim.12269.

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  1. Department of Nephrology, Radboud University Medical Centre, PO Box 9101, Nijmegen, 6500 HB, Netherlands

    Jeroen Deegens & Jack Wetzels

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Correspondence to Jack Wetzels.

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Deegens, J., Wetzels, J. Measurement of serum suPAR is not ready for clinical use. Nat Rev Nephrol 10, 610 (2014). https://doi.org/10.1038/nrneph.2014.113-c2

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