Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 28, 2016; 8(33): 1471-1477
Published online Nov 28, 2016. doi: 10.4254/wjh.v8.i33.1471
Elevation of serum urokinase plasminogen activator receptor and liver stiffness in postoperative biliary atresia
Wanvisa Udomsinprasert, Sittisak Honsawek, Napaphat Jirathanathornnukul, Voranush Chongsrisawat, Yong Poovorawan
Wanvisa Udomsinprasert, Sittisak Honsawek, Napaphat Jirathanathornnukul, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
Voranush Chongsrisawat, Yong Poovorawan, Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
Author contributions: Honsawek S designed the study; Udomsinprasert W, Honsawek S and Jirathanathornnukul N performed the research; Udomsinprasert W, Honsawek S, Jirathanathornnukul N, Chongsrisawat V and Poovorawan Y analyzed the data; Chongsrisawat V and Poovorawan Y examined all the patients and collected the clinical data; Udomsinprasert W and Honsawek S wrote the paper; Honsawek S revised the manuscript for final submission.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board on Human Research of the Faculty of Medicine, Chulalongkorn University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at sittisak.h@chula.ac.th. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sittisak Honsawek, MD, PhD, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Road, Patumwan, Bangkok 10330, Thailand. sittisak.h@chula.ac.th
Telephone: +662-256-4482 Fax: +662-256-4482
Received: June 5, 2016
Peer-review started: June 7, 2016
First decision: August 10, 2016
Revised: August 21, 2016
Accepted: October 22, 2016
Article in press: October 24, 2016
Published online: November 28, 2016
Processing time: 172 Days and 11.1 Hours
Abstract
AIM

To investigate serum urokinase-type plasminogen activator receptor (uPAR) and liver stiffness in biliary atresia (BA) and examine the correlation of circulating uPAR, liver stiffness, and clinical outcomes in postoperative BA children.

METHODS

Eighty-five postKasai BA children and 24 control subjects were registered. Circulating uPAR was measured using enzyme-linked immunosorbent essay. Liver stiffness was analyzed using transient elastography.

RESULTS

BA children had significantly greater circulating uPAR and liver stiffness scores than control subjects (P < 0.001). Circulating uPAR and liver stiffness were substantially higher in jaundiced BA children than non-jaundiced BA children (P < 0.001). In addition, circulating uPAR was positively associated with serum aspartate aminotransferase (r = 0.507, P < 0.001), alanine aminotransferase (r = 0.364, P < 0.001), total bilirubin (r = 0.559, P < 0.001), alkaline phosphatase (r = 0.325, P < 0.001), and liver stiffness scores (r = 0.508, P < 0.001).

CONCLUSION

Circulating uPAR and liver stiffness values were greater in BA children than healthy controls. The increased circulating uPAR was associated with liver dysfunction in BA. As a consequence, serum uPAR and liver stiffness may be used as noninvasive biomarkers indicating the progression of liver fibrosis in postKasai BA.

Keywords: Biliary atresia; Jaundice; Liver stiffness; Severity; Urokinase plasminogen activator receptor

Core tip: Urokinase plasminogen activator receptor (uPAR) is known to be a substantial factor in the etiopathogenesis of hepatic inflammation and liver fibrogenesis. This study is the first to show that circulating uPAR is more elevated in biliary atresia (BA) children than in control subjects, and that circulating uPAR is correlated with the degree of jaundice and liver fibrosis in biliary atresia. Elevated serum uPAR is positively correlated with the severity of liver stiffness in postKasai BA children. Hence, serum uPAR could be used as a biological parameter indicating the progression and prognosis of liver fibrosis in BA children.