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Clinical Chemistry 43: 1868-1876, 1997;
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(Clinical Chemistry. 1997;43:1868-1876.)
© 1997 American Association for Clinical Chemistry, Inc.


Articles

ELISA determination of soluble urokinase receptor in blood from healthy donors and cancer patients

Ross W. Stephens1,a, Anders N. Pedersen1, Hans Jørgen Nielsen, Maria J. A. G. Hamers1, Gunilla Høyer-Hansen1, Ebbe Rønne1, Esben Dybkjær, Keld Danø1 and Nils Brünner1

1 The Finsen Laboratory, Rigshospitalet, Copenhagen, Denmark.
a Address correspondence to this author at: The Finsen Laboratory, Strandboulevarden 49, DK-2100 Copenhagen, Denmark. Fax +45 31 38 54 50; e-mail p1000027{at}inet.uni-c.dk


   Abstract
Top
Abstract
Introduction
Materials and Methods
Results
Discussion
References
 
Measurement of urokinase receptor (uPAR) in tumor extracts has prognostic value, but assay of the soluble uPAR (suPAR) in peripheral blood may offer wider applications in cancer patient management. A tumor extract uPAR ELISA was modified to eliminate nonspecific plasma protein interference, enabling specific detection of suPAR in plasma and sera with >90% recovery of added calibrator. suPAR concentrations in citrate plasma correlated with sera in 93 healthy blood donors (r = 0.84, P <0.0001), with a median value for both of 1.2 µg/L. The plasma median for 19 advanced breast cancer patients was 2.9 µg/L suPAR, and a similar increase was found for 10 advanced colon cancer patients, consistent with release of suPAR from tumors into blood. Repetitive monitoring of suPAR in cancer patients' blood may have value in assessment of prognosis and tumor recurrence.


   Introduction
Top
Abstract
Introduction
Materials and Methods
Results
Discussion
References
 
The central role of urokinase plasminogen activator (uPA) in promoting tumor invasion is now well established (1)(2)(3)(4).1 uPA is secreted as an inactive proenzyme (pro-uPA) (5)(6)(7), which, after binding to a cell-surface high-affinity receptor (uPAR) (8), can be rapidly activated to uPA by cell-surface-bound plasmin (9)(10). uPAR localizes uPA enzyme activity at the cell-surface contacts with other cells and the extracellular matrix (11), and the plasmin subsequently produced at these sites mediates the nonspecific proteolysis that facilitates migration of tumor cells through restraining tissue structures (12). To realize its full proteolytic potential, assembly of the uPA system requires plasma membrane display of uPAR, occupancy of the receptor by bound pro-uPA, and the proximity of bound plasmin/plasminogen, which serves to activate pro-uPA and continuously propagate uPA and plasmin activities (10). Some of the essential components may be contributed by tumor cells, others by stromal cells that the tumor cells recruit or induce to actively participate in tissue destruction (13)(14)(15). The most aggressive tumors are now known to efficiently bring together a highly active uPA system, but the contributions of tumor and stromal cells to the complete system differs substantially between different types of cancers.

Measurement of the protein components of the urokinase system in tumor extracts reveals that high concentrations of uPA, uPAR, and plasminogen activator inhibitor type 1 (PAI-1) are associated with shorter survival of breast cancer patients (16)(17)(18)(19)(20)(21)(22)(23), and therefore may be used as prognostic markers. Clearly, determination of these indicators has value in the clinical setting, but suitable tissue extracts require careful tissue handling, compete with the needs of histopathology, and need optimized and calibrated extraction procedures. It would seem highly desirable to replace the requirement for a tissue sample with a sample of peripheral blood. This would also permit monitoring of the effect of treatment and the course of disease progression, which is not possible when only surgically removed tumor tissue samples are analyzed.

It is therefore important to note that soluble uPAR (suPAR) has been detected in plasma (24), and it seems plausible that this form has been released from the surface of cells. The cell-surface receptor consists of a glycolipid-anchored three-domain 60-kDa glycoprotein, the N-terminal domain 1 of which contains the binding site for the growth factor domain of uPA (25)(26). Cleavage of the glycolipid anchor by a phospholipase (25), and proteolytic cleavage between domains 1 and 2 (27), are two known ways in which release of soluble receptor forms may occur. Because the proteolytic activity of uPA can cleave its own receptor both in vitro and in vivo (28)(29), measurement of suPAR in blood may be a more accessible and reliable indicator of the activity of the uPA system in vivo. In this paper we extend our earlier findings (24) to better define optimal conditions for assay of suPAR in human blood and to establish values in healthy donors. Further, we report preliminary findings of increased plasma suPAR concentrations in patients with advanced cancers.


   Materials and Methods
Top
Abstract
Introduction
Materials and Methods
Results
Discussion
References
 
blood donors and patients
Blood samples from healthy donors were obtained through the cooperation of the blood bank at the Hvidovre University Hospital, Copenhagen. For comparison of serum and plasma, blood was collected from 93 donors—51 men ages 19 to 59 years (median 41 years) and 42 women ages 20 to 64 years (median 36 years). Collections for EDTA and heparin plasma were made from healthy donors of closely similar age and gender distribution. Blood samples were also obtained with informed consent from 19 stage IV breast cancer patients (ages 45 to 70 years) at the Oncology Department, Herlev University Hospital, Copenhagen, and from 10 Duke's stage D colorectal cancer patients (ages 39 to 81 years) at the Department of Surgical Gastroenterology, Hvidovre University Hospital, Copenhagen. Permission was obtained from the local Ethical Committees.

blood collections and plasma and serum separation
Peripheral venous blood was drawn into prechilled citrate, EDTA, or heparin collection tubes (Becton Dickinson) and quickly mixed by inversion. The plasma was separated from blood cells within 1.5 h by centrifugation at 4 °C at 1200g for 30 min, and stored frozen at -80 °C before assay. Blood collected into dry tubes was allowed to clot at room temperature and the serum was carefully collected no later than 30 min from collection. Plasma and serum pools were made with freshly collected samples from at least 10 donors, aliquoted, and stored frozen at -80 °C.

modified supar elisa
Immunoassay plates (Maxisorp, Nunc) were coated for 16 h at 4 °C with 100 µL/well of purified rabbit anti-human uPAR IgG (0.5 mg/L) in 0.1 mol/L carbonate buffer, pH 9.5. This catching antibody was previously absorbed on a column of mouse IgG to reduce the ELISA background. Before use, the assay wells were rinsed twice with 200 µL/well of SuperBlockTM solution (Pierce Chemicals) diluted 1:1 with PBS, followed by three washes with PBS containing 1 g/L Tween 20. Wells were then treated for 1 h at 37 °C with 100 µL/well of triplicate or duplicate 1:10 dilutions of plasma or serum made in a sample dilution buffer of 50 mol/L phosphate, pH 7.2, 0.1 mol/L NaCl, 10 g/L bovine serum albumin (Fraction V, Boehringer Mannheim), and 1 g/L Tween 20. On every assay plate a series of calibrators was included that consisted of seven serial dilutions in triplicate of purified recombinant suPAR (i.e., uPAR lacking the glycolipid anchor; see ref. 30), starting from 1 µg/L, then 0.5, 0.25, 0.125, 0.0625, 0.0313, and 0.0156 µg/L. Also included on each plate were triplicate blank wells containing only sample dilution buffer, and triplicate wells of a 1:10 dilution of a control citrate plasma pool.

After suPAR binding, the wells were washed six times, then treated for 1 h at 37 °C with 100 µL/well of a mixture of three murine monoclonal anti-human uPAR antibodies [R2 (23 µg/L), R3 (281 µg/L), and R5 (70 µg/L); see refs. 24 and 31] in sample dilution buffer. After six washes the wells were then incubated for 1 h at 37° with 100 µL/well of rabbit anti-mouse immunoglobulins–alkaline phosphatase conjugate (Dako) diluted 1:1000 in sample dilution buffer. After six washes with washing solution and three washes with pure water, 100 µL of freshly made p-nitrophenyl phosphate (Sigma) substrate solution (1.7 g/L in 0.1 mol/L Tris-HCl, pH 9.5; 0.1 mol/L NaCl; 5 mmol/L MgCl2) was added to each well and the plate was placed in a Ceres 900TM plate reader (Bio-Tek Instruments). The yellow color development at 23 °C was monitored automatically, with readings taken at 405 nm against an air blank every 10 min for 60 min. KinetiCalc II software was used to manage the data, calculate the rate of color change for each well (linear regression analysis), and compute from the rates for the suPAR calibrators a four-parameter fitted calibration curve from which the suPAR concentration of each plasma or serum sample was calculated. Development of color in each well was a linear function of time for all concentrations of suPAR measured in these experiments (see Fig. 1 A), with correlation coefficients for the automatically fitted lines typically better than 0.97. The calibration curve of the rates plotted against the suPAR concentration was slightly sigmoidal from 0 to 1.0 µg/L and the correlation coefficient for the four-parameter fit was typically better than 0.999 (see Fig. 1B ). The rate with no suPAR (read against air) was 0.167 ± 0.039 (mean ± SD) milliabsorbance units/min (n = 46), whereas the rate with 1.0 µg/L calibrator suPAR was 12.16 ± 1.48 milliabsorbance units/min (n = 46). The limit of detection for the assay, defined as the concentration of suPAR corresponding to a signal 3 SD above the mean for the suPAR blank, was 16 ng/L or 1.3% of the mean concentration found in healthy plasma. The intraassay CV for 10 replicates of a control citrate plasma pool measured on the same plate was 6.5%, and the interassay CV for 24 successive assays of the plasma pool (on different days) was 14%. This plasma pool had a suPAR content of 1.07 µg/L. The interassay CV of another plasma pool with suPAR content of 1.83 µg/L was 11% (n = 27). Thus the precision did not change markedly across a suPAR concentration range representing a large proportion of the healthy blood samples assayed (median suPAR concentration 1.2 µg/L).



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Figure 1. (A) Kinetic ELISA for suPAR and (B) suPAR calibration curve.

(A) Progress curves for the change in absorbance at 405 nm produced by hydrolysis of p-nitrophenyl phosphate by solid-phase alkaline phosphatase immunoconjugate. The data shown were generated by four individual assay wells treated with four different concentrations of purified recombinant suPAR: 0.25 µg/L ({blacksquare}-{blacksquare}), 0.125 µg/L ({blacktriangleup}-{blacktriangleup}), 0.0625 µg/L (•-•), and 0 µg/L ({circ}-{circ}). The lines shown have been fitted by simple linear regression. (B) ELISA well absorbance measurements for triplicate suPAR calibrators in the range 0.0–1.0 µg/L were collected automatically over 60 min, with readings taken at 405 nm every 10 min. Progress curves were computed for each assay well, and the rates thus obtained were fitted to a calibration curve with a four-parameter equation of the form y = d + {(a - d)/[1 + (x/c)b]}. In the example curve shown, the four derived parameters had the following values: a = 0.254, b = 1.20, c = 4.84, and d = 82.9. The R2 value for the fitted curve was >0.999.

immunoabsorption of supar in citrate plasma pool
Citrate plasma pool (1.0 mL) was diluted 1:10 with sample dilution buffer (9 mL), then preabsorbed to remove human IgG by repeated passage through a 0.6-mL column of protein A–Sepharose (Pharmacia). The preabsorbed plasma (2 mL) was applied to a 0.4-mL column of protein A–Sepharose cross-linked through dimethylpimelimidate (32) with 48 µg of monoclonal antibody against trinitrophenyl hapten (anti-TNP; irrelevant antibody control (24)). Another aliquot of preabsorbed plasma (2 mL) was applied to a 0.4-mL column of protein A–Sepharose cross-linked with a mixture of two monoclonals against uPAR, R4 and R9 (each 48 µg), and a further aliquot (2 mL) was applied to a 0.4-mL column of protein A–Sepharose cross-linked with 48 µg of rabbit anti-uPAR (suPAR ELISA catching antibody). Samples of plasma pool before preabsorption, after preabsorption, after anti-TNP absorption, after R4/R9 absorption, and after anti-uPAR absorption were assayed for suPAR by ELISA as above.

recovery of calibrator supar signal in plasma and serum pools
The recovery of signal from calibrator suPAR was measured after addition to 1:10 dilutions of citrate and EDTA plasma pools, and a 1:10 dilution of serum pool. Calibrator suPAR was added to these solutions to final concentrations from 0 to 1.0 µg/L. The recoveries in each case were calculated from the slopes of the lines representing suPAR signal as a function of concentration, where 100% recovery was defined as the slope obtained when suPAR was diluted in the sample dilution buffer.


   Results
Top
Abstract
Introduction
Materials and Methods
Results
Discussion
References
 
supar epitope contributions to the elisa signal
The ELISA used in this study had three murine monoclonal antibodies for detection of human suPAR: R2, R3, and R5 in the concentration ratios 1:12:3, respectively. The epitope recognized by R2 is located in domain 3 of uPAR, whereas R3 and R5 both bind epitopes in domain 1. These are the same antibodies used in the ELISA developed by Rønne et al. (31) for assay of uPAR in tumor extracts (17). However, the use of biotinylated antibodies in plasma suPAR assays was found to exhibit a significant nonspecific signal (Stephens et al., manuscript in preparation), and so the studies reported here included nonbiotinylated R2, R3, and R5, and a second antibody conjugate: rabbit anti-mouse immunoglobulins coupled to alkaline phosphatase. This second antibody was supplied already absorbed with human IgG, so that a low background signal was obtained from plasmas and serum in the absence of the detection monoclonals (Fig. 2 ).



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Figure 2. Epitope contributions to suPAR ELISA signal.

Calibrator suPAR (0.2 µg/L) (suPAR), or 1:10 dilutions of citrate plasma pool (Citrate), EDTA plasma pool (EDTA), and serum pool (Serum) were allowed to bind to rabbit anti-human uPAR-coated microtiter plate wells. The solid phase was then probed with either no monoclonal antibodies (), a mixture of R3 and R5 monoclonal anti-human uPAR antibodies ({square}), R2 and R5 (), R2 and R3 (), and R2, R3, and R5 together ({blacksquare}). Finally the wells were treated with rabbit antibodies to mouse immunoglobulins, conjugated to alkaline phosphatase. The phosphatase activity measurement (rate) obtained with no antigen and the complete monoclonal mixture was used as the blank in all subsequent experiments. In the figure the column height shows the mean rate and the bars show the duplicate rates for each antibody mixture.

The contribution of each monoclonal detection antibody to ELISA signal was determined by measurements with monoclonal mixtures lacking one of the three monoclonal antibodies at a time. In the concentration range of suPAR calibrator comparable with that found in a 1:10 dilution of plasma or serum from a healthy donor (i.e., 0.1 to 0.2 µg/L), R2 contributed ~65–70% of the ELISA signal and R3 contributed 25–35% (Fig. 2Up ), whereas R5 only contributed significantly at higher suPAR concentrations (not shown). A closely similar epitope pattern was found for the signal from 1:10 dilutions of citrate plasma pool, EDTA plasma pool, and serum pool (see Fig. 2Up ). Thus the epitope contributions to the signal for endogenous suPAR in plasma and serum were consistent with the presence of full-length suPAR, comprising all three protein domains.

immunoabsorption of supar elisa signal
When citrate plasma pool was absorbed on a protein A–Sepharose column with two anti-uPAR monoclonal antibodies (R4 and R9) different from those used in the ELISA, the suPAR signal in the subsequent ELISA was reduced by ~80% (Fig. 3 ). The epitope recognized by R4 is located in domain 3 of uPAR, whereas R9 binds to an epitope in domain 1 (9). Absorption with protein A–Sepharose alone removed only some 10% of the signal, as did protein A–Sepharose with an irrelevant monoclonal antibody (anti-TNP) of the same IgG subclass (Fig. 3 ). If the plasma pool was absorbed with the same rabbit polyclonal antibody as used for catching in the ELISA, then the signal was totally abolished (Fig. 3 ).



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Figure 3. Immunoabsorption of ELISA signal.

Citrate plasma pool (Pool) was preabsorbed with protein A–Sepharose (ProtA), then either with two monoclonals to uPAR (R4R9), or monoclonal anti-TNP (TNP) or rabbit anti-uPAR (RP). The treated samples were then assayed for suPAR by ELISA. The values shown are means of triplicates, with the SE shown as error bars.

recovery of supar calibrator after dilution in plasma and serum
Specific signal recovery was determined by addition of increasing concentrations of purified suPAR calibrator to a fixed 1:10 dilution of plasma or serum pool and subsequent measurement of the ELISA signal. In diluted citrate plasma pool, 96% recovery of suPAR signal was obtained, 91% in diluted EDTA plasma pool and 94% in diluted serum pool (Fig. 4 A). Loss of specific suPAR signal after addition to samples was therefore barely significant.



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Figure 4. (A) Recovery of ELISA signal from calibrator suPAR added in increasing concentration to assay dilution buffer (•-•), 1:10 dilution of citrate plasma pool ({circ}-{circ}), 1:10 dilution of EDTA plasma pool ({square}-{square}), and 1:10 dilution of serum pool ({triangleup}-{triangleup}), and (B) effect of dilution of citrate plasma pool ({circ}-{circ}), EDTA plasma pool ({square}-{square}), and serum pool ({triangleup}-{triangleup}) on the respective suPAR signals subsequently obtained by ELISA assay.

Values shown are the means of triplicates. The correlation coefficient for each fitted line was (A) >0.98 and (B) for each fitted curve >0.94.

dilution curves for plasma and serum supar signal
The suPAR ELISA signal produced by different dilutions of citrate plasma pool, EDTA plasma pool, and serum pool are shown in Fig. 4BUp . Serum gave the best linearity of signal as a function of dilution, while EDTA and citrate plasmas showed some curvature. However, the error due to nonlinearity was not considered significant at 1:10 dilution and this dilution was therefore used in all subsequent determinations.

supar in citrate plasma and serum from the same healthy donors
A collection of citrate plasma and serum samples taken simultaneously from 93 healthy donors was available for this study. The percentile plots for suPAR concentrations determined in these samples are shown in Fig. 5 . The values in each set approximated a normal distribution; the citrate plasma suPAR concentrations had a reference range (10th to 90th percentile) of 0.82 to 1.7 µg/L, and the mean of 1.2 ± 0.34 µg/L was indistinguishable from the median (Table 1 ). Similarly, the reference range for the serum suPAR concentrations was 0.92–1.8 µg/L, and the mean of 1.3 ± 0.39 µg/L was close to the median of 1.2 µg/L (Table 1 ). A paired means comparison showed that the concentration in citrate plasma is significantly lower by 0.12 µg/L (95% lower 0.077, 95% upper 0.16, P <0.0001) than the concentration in serum from the same individual. However, this likely reflected the small and variable systematic error (x ~9/10) introduced by dilution of whole blood with citrate buffer in the plasma preparation. The concentration of suPAR in serum correlated with citrate plasma from the same individuals: The linear regression plot in Fig. 6 has a regression coefficient of 0.84, and a nonparametric Spearman's rank test for the data set gave {rho} = 0.84 and P <0.0001.



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Figure 5. Percentiles plot for the concentration of suPAR (µg/L) measured by ELISA in citrate plasma samples and sera from healthy blood donors.

Blood from each of 93 healthy donors was collected into citrate anticoagulant and dry tubes for separation of plasma and serum, respectively. suPAR concentrations were determined by ELISA in each plasma ({circ}) and corresponding serum (•) sample by ELISA after 1:10 dilution.


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Table 1. Summary of suPAR concentrations determined in blood from healthy donors.



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Figure 6. Linear regression plot for the concentration of suPAR in serum samples compared with citrate plasma from the same individuals.

The equation of the fitted line is y = 0.16 + 0.97x, with a regression coefficient of 0.84.

tests for correlations to gender and age of donor
The percentiles, divided according to gender, for suPAR in 93 serum samples are shown in Fig. 7 . The median value for 51 men was 1.1 µg/L and for the 42 women in this set it was 1.4 µg/L. A Mann–Whitney U-test indicated that a difference may exist between the two populations (P = 0.04). There was no significant correlation between serum suPAR concentration and age of the donors (Spearman's {rho} = 0.12, P = 0.24).



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Figure 7. Percentiles plot for the concentration of suPAR (µg/L) measured by ELISA in 93 serum samples from healthy donors, divided for the 51 men (•) and 42 women ({circ}).

plasma sets prepared with edta and heparin
Two other sets of plasmas from healthy donors, made with EDTA and heparin anticoagulants, were analyzed for suPAR. For EDTA plasmas (Table 1Up ), the reference range for 44 donors was 1.2–1.9 µg/L with a mean of 1.5 ± 0.34 µg/L and a median of 1.5 µg/L. For heparin plasmas, the reference range for 46 donors was 0.83–1.7 µg/L with a mean of 1.2 ± 0.41 µg/L and a median of 1.1 µg/L (Table 1Up ). Unpaired t-tests showed that there was no significant difference between the means for serum and heparin plasma (P = 0.11), and between citrate and heparin plasma (P = 0.93). There were significant differences between the means for serum and EDTA plasma (P = 0.003), citrate plasma and EDTA plasma (P < 0.0001), and heparin plasma and EDTA plasma (P = 0.0001). The mean concentration of suPAR in EDTA plasma was 0.33 µg/L higher than the mean for citrate plasma (95% lower 0.21, 95% upper 0.45). Thus it is important that the same blood preparation is used consistently for comparisons of different donor groups, or for comparison of healthy donor sets with patient material.

preliminary studies of plasma supar concentrations in patients with advanced malignancies
A pilot study was carried out in which the suPAR concentrations were measured in 19 citrate plasma samples from advanced (stage IV) breast cancer patients (see Fig. 8 ). The 10th to 90th percentile range of suPAR in the breast cancer plasmas was 1.9–7.1 µg/L, with a mean of 3.9 ± 4.0 µg/L and a median of 2.9 µg/L, compared with the reference range of 0.82–1.7 µg/L with a mean of 1.2 ± 0.35 µg/L and a median of 1.2 µg/L for 42 citrate plasma samples from healthy female donors. A Mann–Whitney U-test for this data indicated a highly significant difference with P <0.0001, but the data set reported is small and all the patients had advanced disease.



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Figure 8. Plasma suPAR concentrations in advanced breast cancer.

suPAR was measured by ELISA in 19 citrate plasma samples from stage IV patients ({circ}) and compared with the suPAR in citrate plasma samples from 42 healthy female donors (•).

We also measured suPAR concentrations in citrate plasma from 10 patients with Duke's stage D colon cancer, and found a 10th to 90th percentile range of 1.4–4.7 µg/L, with a mean of 2.3 ± 1.3 µg/L and a median of 1.9 µg/L. This was also significantly different (Mann–Whitney U-test, P <0.0001) from the suPAR concentration in citrate plasmas from healthy individuals.


   Discussion
Top
Abstract
Introduction
Materials and Methods
Results
Discussion
References
 
ELISA quantification of plasma suPAR was first described by Rønne et al. (24), who applied an ELISA developed originally for measurement of uPAR in human tumor extracts (17)(31)(33). This ELISA consisted of rabbit anti-uPAR catching antibodies and a mixture of three biotinylated murine monoclonal antibodies (R2, R3, and R5) for detection. When studies of plasma and sera were extended in the present study we found it necessary to modify the detection method to eliminate a source of nonspecific signal that could be traced to the use of biotinylated reagents (34). Thus in the studies reported here, binding of the same detection monoclonals was followed by rabbit anti-mouse immunoglobulin conjugated with alkaline phosphatase. Other changes were made including use of a rapid blocking agent, a dilution buffer with higher buffering capacity, and alkaline phosphatase as the enzyme conjugate to allow kinetic assay of the bound antigen. These other modifications gave some improvement in signal-to-noise ratio, and kinetic assay permitted automated fitting of rate curves, which proved considerably more reliable than single end-point measurements. With this protocol, the assay fulfilled the requirements of sensitivity, specificity, stability, and good recovery of an internal calibrator.

The epitope contributions to total suPAR signal that we have found in ELISAs of healthy donor plasma and serum samples suggest that suPAR is present in plasma as the full-length, three-domain receptor protein. Many cell-surface proteins have been found to have soluble counterparts (35), and in vivo this gives rise to soluble receptors circulating in the blood. In some cases these have already proven to be useful diagnostic indicators (e.g., 36–38). The occurrence of suPAR in healthy human plasma has been conclusively demonstrated previously by immunoaffinity purification and cross-linking to 125I-labeled amino-terminal fragment of human uPA (24). Thus in these earlier studies the soluble receptor present in plasma was able to efficiently bind its ligand, and therefore most probably consisted of more than domain 1. If the suPAR had been proteolytically cleaved to the known products (i.e., domains 2 + 3, and domain 1), then the affinity for uPA would have been reduced by ~1500-fold (39). Moreover, full-length suPAR was also indicated by the molecular mass of the labeled cross-linked uPA/suPAR complex (24). Our epitope studies provide additional evidence for full-length suPAR protein in the peripheral blood of healthy people. This soluble form has been found in the culture supernatant of human HT-1080 fibrosarcoma cells, from which it may be released by the action of a phospholipase (40). In patients with the hereditary disease of paroxysmal nocturnal hemoglobinuria, a defect in the C-terminal processing of the receptor prevents its anchorage in the plasma membrane of blood neutrophils, and increased concentrations of full-length suPAR protein are therefore found in blood from these patients (24). However, the tissue origin of the suPAR found in human blood from healthy donors has not been established, nor is the mechanism by which it is released in vivo, or the functional significance it may have.

Our quantitative studies of soluble receptor in blood from healthy donors show that all forms of blood preparations appear to be suitable for ELISA determination of suPAR concentrations—serum as well as plasma made with citrate, EDTA, or heparin anticoagulant. Delay in processing blood did not seem to be a significant source of error, at least in the first hour after collection, implying that neutrophils in healthy blood are not rapidly shedding suPAR. On the contrary, inflammatory neutrophil exudates have previously been shown to contain considerable amounts of suPAR (41). Similar median values and ranges were found for healthy serum, citrate plasma, and heparin plasma, but the concentration of suPAR in EDTA plasma was significantly higher. If comparisons of donor groups or healthy donors with patient material are to be valid, the same blood preparation (e.g., serum) should be used consistently. If the receptor is considered as the full-length protein of Mr ~60 000, the median of 1.2 µg/L for citrate plasma and serum corresponds to a molar concentration of ~20 pmol/L (cf. 28 pmol/L found in ref. 24). The receptor ligand uPA also occurs in plasma at only ~20 pmol/L (42), so given that the binding affinity of the receptor is ~100 pmol/L, it would seem that the majority of the receptor in vivo is unoccupied by uPA. It is probably for this reason that Pedersen et al. (43) were able to affinity-purify suPAR from plasma of ovarian cancer patients with a column of immobilized uPA. At least some of the suPAR present in sepsis plasma was also able to bind uPA (41).

The remodeling of tissues that characterizes several physiological and pathological events, such as wound healing, trophoblast invasion, and tumor invasion, is well known to involve the proteolytic activity of the urokinase system in degrading tissue matrix. Increases in uPAR expression occur in such events and a corresponding increase in suPAR in blood may be a consequence of this. In our studies, an indication of this possibility is found in the slightly higher suPAR serum concentrations in women compared with men. One possible explanation of this is the increased activity of the uPA system in ovulation, and menstrual degradation of uterine endometrium (44). To study this possibility, a considerably larger number of blood samples from postmenopausal women would be required than were obtainable from our collections of voluntary blood donors that included only four women age 50 years or more.

However, in cancer the uPA system is clearly very active in many types of tumors, and uPAR is often overexpressed. Furthermore, the concentration of suPAR released by cells within a tumor appears to be more closely related to prognosis than the total membrane-bound fraction of uPAR (17), suggesting that measurement of suPAR in blood in malignancy may have important prognostic value. Appreciable amounts of suPAR have been previously identified and characterized in plasma and ascites fluid from ovarian cancer patients (43), and more recently increased concentrations of suPAR have been found in plasma from non-small-cell lung cancer patients (45). With the quantitative ELISA described above, our preliminary findings suggest that increases in the concentration of plasma suPAR are also found in patients with advanced cancers of breast and colon.


   Acknowledgments
 
We thank the Oncology Department, Herlev University Hospital, and the blood bank and Department of Surgical Gastroenterology at the Hvidovre University Hospital. This work was supported by the University of Copenhagen, the Danish Cancer Society, the Danish Cancer Research Fund, the Ingeborg Roikjer Foundation, and the Clinical Research Unit, Oncology Department, Herlev University Hospital.


   Footnotes
 
Departments of 2 Surgical Gastroenterology and 3 Clinical Immunology, Hvidovre University Hospital, Hvidovre, Denmark.

1 Nonstandard abbreviations: uPA, urokinase plasminogen activator; pro-uPA, proenzyme form of uPA; uPAR, cell-surface uPA receptor; suPAR, soluble uPAR; and TNP, trinitrophenyl hapten.


   References
Top
Abstract
Introduction
Materials and Methods
Results
Discussion
References
 

  1. Pöllanen J, Stephens RW, Vaheri A. Directed plasminogen activation at the surface of normal and malignant cells. Adv Cancer Res 1991;57:273-328. [Web of Science][Medline] [Order article via Infotrieve]
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  3. Ossowski L, Clunie G, Masucci MT, Blasi F. In vivo paracrine interaction between urokinase and its receptor: effect on tumor cell invasion. J Cell Biol 1991;115:1107-1112. [Abstract/Free Full Text]
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