Clinical value of soluble urokinase-type plasminogen activator receptor (SuPAR) as a biomarker of disease activity in Behcet’s disease


Behçet's disease, suPAR, disease activity, inflammation.

How to Cite

Rizk, A., Abdelfattah, W., Al-Shaarawy, A. and Elsaid, N. 2021. Clinical value of soluble urokinase-type plasminogen activator receptor (SuPAR) as a biomarker of disease activity in Behcet’s disease. Rheumatology (Bulgaria). 29, 4 (Dec. 2021), 47-52. DOI:


Background: Behçet's disease (BD) is a chronic multisystemic vasculitic disease of unknown pathogenesis. Diagnosis and disease activity measurement has always been a challenge. Soluble urokinase plasminogen activator receptor (suPAR) is showing an increased utility as a promising diagnostic and prognostic inflammatory biomarker in different systemic inflammatory disorders.

Objectives: To study the clinical value of plasma Soluble urokinase plasminogen activator receptor (suPAR) in patients with Behçet's disease, and if it can be used as a measure to disease activity.  Methods: According to the International Criteria for Behcet's Disease (ICBD), fifty adult Behçet's disease patients were enrolled in the study, and forty healthy adult subjects were included in a case-control study. An enzyme-linked immunosorbent assay was used to obtain quantitative data. Results: The suPAR level was not statistically different between the patients with BD patients and the controls. No correlation was found between suPAR levels and disease activity (BDFAC). Conclusion: Very few studies analyzed the clinical value of suPAR level in patients with BD and its correlation with disease activity. Our results show that suPAR does not seem to play a role in the disease mechanism of BD.

Keywords: Behçet's disease, suPAR, disease activity, inflammation.


  1. -Kokturk A. Clinical and Pathological Manifestations with Differential Diagnosis in Behçet's Disease. Patholog Res Int 2012:690390. Doi:10.1155/2012/690390.
  2. - Kaufman WS, McNamara EK and Jorizzo JL. “Behçet's Disease” Kelley and Firestein's Textbook of Rheumatology 2017 pp.1589 —1596.
  3. - Türsen U. Pathophysiology of the Behçet's Disease. Patholog Res Int. 2012:493015. Doi:10.1155/2012/493015.
  4. - Iba T and Levy JH. “Inflammation and thrombosis: roles of neutrophils, platelets and endothelial cells and their interactions in thrombus formation during sepsis.” J Thromb Haemost.; 2018 Feb;16(2):231-241. PMID: 29193703 Doi: 10.1111/jth.13911
  5. - Periayah MH, Halim AS and Mat Saad AZ. Mechanism Action of Platelets and Crucial Blood Coagulation Pathways in Hemostasis. International Journal of Hematology-Oncology and Stem Cell Research; 2017,11(4):319-327.PMID: 29340130; PMCID: PMC5767294.
  6. - Graf C and Ruf W. “Tissue factor as a mediator of coagulation and signaling in cancer and chronic inflammation.” Thromb Res; 2018Apr;164 Suppl 1: S143-S147. Doi: 10.1016/j.thromres.2018.01.023
  7. - Jaiswal RK, Varshney AK and Yadava PK. “Diversity and functional evolution of the plasminogen activator system.” Biomed Pharmacother; 2018, Feb; 98:886-898. Doi: 10.1016/j.biopha.2018.01.029.
  8. - Ventorp F, Gustafsson A, Träskman-Bendz L et al. “Increased Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR) Levels in Plasma of Suicide Attempters.” PLoS One; 2015, Oct 9;10(10): e0140052 Doi: 10.1371/journal.pone.0140052. eCollection 2015.
  9. - Vasarhelyi B, Toldi G, and Balog A “The Clinical Value of Soluble Urokinase Plasminogen Activator Receptor (suPAR) Levels in Autoimmune Connective Tissue Disorders” EJIFCC; 2016 Apr 20;27(2):122-9. PMID: 27683525 PMCID: PMC4975228.
  10. -Desmedt S, Desmedt V, Delanghe JR, et al. “The intriguing role of soluble urokinase receptor in inflammatory diseases.” Crit Rev Clin Lab Sci; 2017 Mar;54(2):117-133. Doi: 10.1080/10408363.2016.1269310.
  11. -Indumati V, Vijay V, Krishnaswamy D, et al.“Serum levels of soluble urokinase plasminogen activator receptor(suPAR) as a marker of tuberculosis treatment efficacy.” Indian J Tuberc; 2017; Jul;64(3):206-211. Doi: 10.1016/j.ijtb.2017.01.012. Epub 2017 Feb 22
  12. -Sidenius N, Sier CF, Ullum H et al. “Serum Level of Soluble Urokinase-Type Plasminogen Activator Receptor Is a Strong and Independent Predictor of Survival in Human Immunodeficiency Virus Infection.” Blood;2000, 96(13): 4091–95. PMDI: 11110678
  13. - Geboers DG, de Beer FM, Tuip-de Boer AM, et al “Plasma suPAR as a prognostic biological marker for ICU mortality in ARDS patients.” Intensive Care Med; 2015, 41:1281–90. Doi: 10.1007/s00134-015-3924-9
  14. -Hildenbrand R, Allgayer H, Marx A et al. Modulators of the urokinase-type plasminogen activation system for cancer. Expert Opin Investig Drugs; 2010,19(5):641–652. Doi:10.1517/13543781003767400.
  15. - Dass K, Ahmad A, Azmi AS et al. Evolving role of uPA/uPAR system in human cancers. Cancer Treat Rev; 2008; 34:122–36. Doi: 10.1016/j.ctrv.2007.10.005.
  16. -Bene MC, Castoldi G, Knapp W et al. CD87(urokinase-type plasminogen activator receptor), function and pathology in hematological disorders: a review. Leukemia; 2004, 18:394–400. Doi: 10.1038/sj.leu.2403250.
  17. -Qin DD, Song D, Huang J et al “Plasma-Soluble Urokinase-Type Plasminogen Activator Receptor Levels Are Associated with Clinical and Pathological Activities in Lupus Nephritis: A Large Cohort Study from China.” Lupus; 2015,24(6): 546–57 Doi: 10.1177/0961203314558857. Epub 2014 Nov 18.
  18. - Thornton S, Rossing P, Eugen-Olsen J et al “Urokinase plasminogen activator and receptor promote collagen-induced arthritis through expression in hematopoietic cells”. Blood Adv. 2017; Mar 21;1(9):545-556. Doi: 10.1182/bloodadvances.2016004002.
  19. -Riisbro R, Christensen IJ, Hogdall C et al “Soluble urokinase plasminogen activator receptor measurements: influence of sample handling”, Int. J. Biol. Mark. 16 (2001) 233–239. Doi: 10.1182/bloodadvances.2016004002.
  20. -Andersen O, Eugen-Olsen J, Kofoed K et al “Soluble urokinase plasminogen activator receptor is a marker of dysmetabolism in HIV-infected patients receiving highly active antiretroviral therapy”, J. Med. Virol. 80 (2008) 209–216. Doi: 10.1002/jmv.21114.
  21. - International Team for the Revision of the International Criteria for Behçet's Disease (ITR-ICBD). The International Criteria for Behçet's Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol. 2014;28(3):338-347. Doi:10.1111/jdv.12107.
  22. -Hatemi G, Silman A, Bang D, et al EULAR recommendations for the management of Behçet disease Annals of the Rheumatic Diseases 2008;67: 1656-1662. Doi: 10.1136/ard.2007.080432.
  23. -Bhakta B, Hamuryudan V, Brennan P et al “Assessment of disease activity in Behçet's disease”. In: Wechsler B, Godeau P, eds. Excerpta Medica International Congress Series 1037, 611.Amsterdam: Elsevier Science;1993 :235–40.
  24. - Cho SB, Cho S, Bang D “New insights in the clinical understanding of Behçet's disease.” Yonsei Med J.;2012, 53(1):35‐42. Doi:10.3349/ymj.53.1.35
  25. - Thuno, Macho B and Eugen-Olsen J “suPAR: The Molecular Crystal Ball.” Disease markers; 2009, 27(3): 157–72. Doi: 10.3233/DMA-2009-0657.
  26. - Birengel S, Yalçındağ FN, Yalçındağ A, et al, “Urokinase plasminogen activator receptor levels in Behcet's disease. Thromb Res.; 2011, Sep;128(3):274-6. Doi: 10.1016/j.thromres.2011.03.003.
  27. - Kurtipek G.S, Kesli R, Akyurek F.T .et al “Plasma‐soluble urokinase plasminogen activator receptor (suPAR) levels in Behçet's disease and correlation with disease activity” Int J Rheum Dis.;2016, Apr;21(4):866-870. Doi:10.1111/1756-185X.12873.
  28. - Tamura Y, Kawao N, Yano M. et al “Role of Plasminogen Activator Inhibitor-1 in Glucocorticoid-Induced Diabetes and Osteopenia in Mice” Diabetes; 2015, Jun; 64(6): 2194-2206. Doi: 10.2337/db14-1192.
  29. - Enocsson H, Wirestam L, Dahle C, et al. Soluble urokinase plasminogen activator receptor (suPAR) levels predict damage accrual in patients with recent-onset systemic lupus erythematosus. Journal of Autoimmunity. 2020 Jan; 106:102340. Doi: 10.1016/j.jaut.2019.102340.
  30. -Enocsson H, Lukic T, Ziegelasch M et al “Serum levels of the soluble urokinase plasminogen activator receptor (suPAR) correlates with disease activity in early rheumatoid arthritis and reflects joint damage over time”, Translational Research, 2021, ISSN 1931-5244, Doi:
  31. - Nowatzky J and Chajek-Shaul T “Biomarkers in Behçet's Disease: Diagnosis and Disease Activity” Int J Clin Rheumatol;2009, 4(3):271-286. Doi:
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