The Diagnostic Potential of Blood Soluble Urokinase Plasminogen Activator Receptor Levels in Lung Cancer and Tuberculosis Patients

Öz

Aim: The study aimed to investigate the potential role of soluble urokinase plasminogen activator receptor (SUPAR) levels in the blood and bronchoalveolar lavage (BAL) fluid for the early diagnosis of lung cancer and tuberculosis (TB). Methods: Bronchoscopy and BAL were performed on 66 patients with a prediagnosis of lung malignancy or tuberculosis. SUPAR levels were measured using the ELISA method and compared with those from 30 healthy individuals as the control group. Results: Blood SUPAR, values were 199.40 ng/L in malignancy patients, 246.09 ng/L in TB patients, and 234.60 ng/L in others. In BAL fluid, values were 56.78 ng/L in lung cancer patients, 39.24 ng/L in TB patients, and 44.00ng/L in other diseases. Significant differences were found in blood SUPAR between patients and controls (p<0.05). The cut-off value for blood SUPAR was 136.61ng/L. Conclusion: Elevated blood SUPAR levels in patients with lung cancer may indicate a nonspecific marker during pre-diagnosis and a prognostic marker for predicting negative outcomes post-diagnosis.

Anahtar Kelimeler

• Bronchoalveolar fluid
• SUPAR
• lung cancer
• tuberculosis.

Kaynakça

1. 1.Davidson KR, Ha DM, Schwarz MI, Chan ED.Bronchoalveolar lavage as a diagnostic procedure: areview of known cellular and molecular findings invarious lung diseases. J Thorac Dis 2020; 12:4991.
2. 2.Radha S, Afroz T, Prasad S, Ravindra N. Diagnosticutility of bronchoalveolar lavage. J Cytol 2014;31:136-8.
3. 3.Dalar L, Sökücü SN, Karasulu AL, Altın S.Tuberculosis Can Mimic Lung Cancer: A Case Series.Turk Thorac J 2013;14.
4. 4.Rasmussen LJH, Petersen JEV, Eugen-Olsen J.Soluble urokinase plasminogen activator receptor(suPAR) as a biomarker of systemic chronicinflammation. Front Immunol 2021; 12:780641.
5. 5.Adams SJ, Stone E, Baldwin DR, et al. Lung cancerscreening. The Lancet. 2023; 401:390-408.
6. 6.Loukeri A, Spithakis P-D, Moschos C, et al: Plasmalevels of soluble urokinase plasminogen activatorreceptor (suPAR) as a possible biomarker for lungcancer and/or COPD. Eur Respiratory Soc; 2016.
7. 7.Günther G, Guglielmetti L, Leu C, et al. Availabilityand costs of medicines for the treatment oftuberculosis in Europe. Clin Microbiol Infect 2023;29:77-84.
8. 8.Rahlwes KC, Dias BRS, Campos PC, Alvarez-Arguedas S, Shiloh MU. Pathogenicity and virulenceof Mycobacterium tuberculosis. Virulence 2023;14:2150449.

9. 9.Bharadwaj AG, Holloway RW, Miller VA, WaismanDM. Plasmin and plasminogen system in the tumormicroenvironment: implications for cancerdiagnosis, prognosis, and therapy. Cancers 2021;13:1838.
10. 10.Eugen-Olsen J, Giamarellos-Bourboulis EJ.suPAR: The unspecific marker for disease presence,severity and prognosis. Int J Antimicrob Agents2015; 46:S33-S4.
11. 11.Olivianto E, Sudarwati S, Nataprawira HM.Soluble urokinase-type plasminogen activatorreceptor as a biomarker of treatment response in childhood tuberculosis. Int J Microbiol Res 2019; 8:262-6.
12. 12.Özdirik B, Stueven A, Knorr J, et al. Solubleurokinase plasminogen activator receptor (suPAR)concentrations are elevated in patients withneuroendocrine malignancies. J Clin Med 2020;9:1647.
13. 13.Hussain YA, Mohammed KAS, Ali NH. PotentialImmunological Biomarker for Diagnosis andPrognosis of Tuberculosis. Eur J Med Res 2023; 2:17-22.
14. 14.Yalcin S, Demir ME, Ozturk R, et al. Prognosticeffects of SuPAR and neopterin levels on patientswith lung cancer. Pteridines. 2020; 31:136-41.
15. 15.Liu KL, Fan JH, Wu J. Prognostic Role ofCirculating SuPAR in Various Cancers: a SystematicReview and Meta-Analysis. Clin Lab 2017; 63:871-80.
16. 16.Wojcik E, Stasik Z, Tarapacz J, et al. suPAR as anadditional prognostic factor in colorectal cancer.Ann Oncol 2017; 28:85.
17. 17.Tucker TA, Idell S. The contribution of theurokinase plasminogen activator and the urokinasereceptor to pleural and parenchymal lung injury andrepair: a narrative review. Int J Mol Sci 2021;22:1437.
18. 18.Luo Q, Ning P, Zheng Y, et al. Serum suPAR andsyndecan-4 levels predict severity of community-acquired pneumonia: a prospective, multi-centrestudy. Crit care. 2018; 22:1-12.
19. 19.Isola G, Polizzi A, Alibrandi A, Williams RC,Leonardi R. Independent impact of periodontitis and cardiovascular disease on elevated soluble urokinase‐type plasminogen activator receptor (suPAR) levels. J Periodontol 2021 ; 92:896-906.
20. 20.Casagranda I, Vendramin C, Callegari T, et al.Usefulness of suPAR in the risk stratification ofpatients with sepsis admitted to the emergencydepartment. Intern Emerg Med 2015; 10:725-30.
21. 21.Refaat A, Affara N, Abdel-fatah W, Hussein T, El-gerbi M. Diagnostic accuracy of inflammatorybiomarkers in bronchoalveolar lavage from patients with ventilator-associated pneumonia. Egypt J Chest Dis Tuberc 2014; 63:723-30.
22. 22.Reisinger AC, Hatzl S, Prattes J, et al. Solubleurokinase plasminogen activator receptor (suPAR)in bronchoalveolar fluid and blood in critically illpatients—a prospective cohort study. Infection2024; 52:249-52.
23. 23.Haupt TH, Rasmussen LJH, Kallemose T, et al.Healthy lifestyles reduce suPAR and mortality in aDanish general population study. Immun Ageing2019; 16:1-12.
24. 24.Rasmussen LJH, Schultz M, Gaardsting A, et al.Inflammatory biomarkers and cancer: CRP andsuPAR as markers of incident cancer in patients with serious nonspecific symptoms and signs of cancer.Int J Cancer 2017 ;141:191-9.
25. 25.Schulz C-A, Persson M, Christensson A, et al.Soluble urokinase-type plasminogen activatorreceptor (suPAR) and impaired kidney function inthe population-based Malmö diet and cancer study.Kidney Int Rep 2017; 2:239-47.