Serum Levels of the Adipokine Progranulin Depend on Renal Function
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Pathophysiology/Complications ORIGINAL ARTICLE Serum Levels of the Adipokine Progranulin Depend on Renal Function 1,2 4 JUDIT RICHTER, MS JURGEN€ KRATZSCH, PHD acrogranin, and granulin-epithelin precur- 1 5 DENISE FOCKE, MD JOACHIM BEIGE, MD 1,2 6 sor) has most recently been introduced as THOMAS EBERT, MD MATTHIAS ANDERS, MD 3 6 a novel adipokine inducing insulin resis- PETER KOVACS, PHD INGOLF BAST, MD 1 1 tance. Thus, Matsubara et al. (5) identified ANETTE BACHMANN, MD MATTHIAS BLUHER€ , MD 1,2 1 progranulin as an adipokine induced by ULRIKE LÖSSNER, BS MICHAEL STUMVOLL, MD 1,2 1,2 a SUSAN KRALISCH, PHD, MSC MATHIAS FASSHAUER, MD TNF- and dexamethasone by differential proteome analysis in cellular models of in- sulin resistance. Furthermore, the authors OBJECTIVEdProgranulin has recently been introduced as a novel adipokine inducing insulin convincingly demonstrated that progranulin resistance and obesity. In the current study, we investigated renal elimination, as well as asso- knockout mice are resistant to high-fat ciation of the adipokine with markers of the metabolic syndrome. diet–induced insulin resistance, adipocyte hypertrophy, and obesity (5). Mechanisti- d fi RESEARCH DESIGN AND METHODS Progranulin serum levels were quanti ed by cally, progranulin deficiency blocked eleva- enzyme-linked immunosorbent assay and correlated to anthropometric and biochemical param- eters of renal function and glucose and lipid metabolism, as well as inflammation, in 532 patients tion of IL-6 in blood and adipose tissue with stages 1–5 of chronic kidney disease (CKD). induced by high-fat feeding (5). Most inter- estingly, progranulin-induced insulin resis- RESULTSdMedian serum progranulin levels adjusted for age, sex, and BMI were significantly tance was suppressed by neutralizing IL-6 different between CKD stages with highest values detectable in stage 5 (stage 1, 58.3 mg/L; stage in vivo (5). In addition, the authors demon- m m m m 2, 63.0 g/L; stage 3, 65.4 g/L; stage 4, 68.8 g/L; and stage 5, 90.6 g/L). Furthermore, CKD strate that progranulin levels in blood and stage was the strongest independent predictor of circulating progranulin in our cohort. In ad- adipose tissue were markedly increased in dition, high-sensitivity interleukin-6 and adiponectin remained significantly and independently correlated with the adipokine. obese mice (5). In agreement with these findings, Youn et al. (6) revealed that serum CONCLUSIONSdWe demonstrate that progranulin serum levels increase with deteriorating concentrations of progranulin were also ele- renal function. These findings are in accordance with the hypothesis that renal clearance is a vated in obese patients, as well as patients major elimination route for circulating progranulin. Furthermore, the adipokine is positively and with type 2 diabetes, compared with indi- fl independently associated with markers of in ammation and adiponectin. viduals with normal glucose tolerance. Furthermore, a study by the same group Diabetes Care 36:410–414, 2013 demonstrated higher progranulin levels in insulin resistant compared with insulin- he incidence of obesity and related genic peptides in the hypothalamus (1). sensitive individuals with morbid obesity Tdisorders including insulin resis- When body weight increases, leptin resis- (7). Interestingly, a recent study by Tönjes tance, type 2 diabetes, dyslipidemia, tance occurs leading to diminished central, et al. (8) suggests that progranulin is asso- and hypertension has increased dramati- appetite-suppressive effects of this adipo- ciated with impaired glucose tolerance cally in recent decades. Hyperplasia and kine despite higher levels in obesity (1). rather than impaired fasting glucose. In ad- hypertrophy of adipocytes during weight Adiponectin, another adipokine, has potent dition, serum levels of progranulin de- fl fl gain in uence the secretion pattern of insulin-sensitizing and anti-in ammatory creased in overweight subjects during a adipose tissue, and altered secretion of effects (2). In contrast, tumor necrosis factor long-term diet intervention indicating a adipocyte-derived proteins, so-called (TNF)-a and interleukin (IL)-6 are proin- fl mechanistic link between body weight adipokines, contributes to the increased ammatory adipokines that correlate with and circulating levels of this adipokine (9). risk for metabolic and cardiovascular increasing body weight and induce insulin Most recently, an elegant study showed diseases in obesity. Thus, the adipokine resistance (3,4). that a combination of four urinary proteins leptin strongly suppresses appetite by in- Progranulin (also referred to as pro- including progranulin could predict early ducing anorexigenic and inhibiting orexi- epithelin, PC-cell–derived growth factor, renal damage in type 1 diabetes, suggesting ccccccccccccccccccccccccccccccccccccccccccccccccc that the adipokine might be involved in From the 1Department of Endocrinology and Nephrology, University of Leipzig, Leipzig, Germany; the the pathogenesis of complications of the 2Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany; the 3Interdisciplinary Center disease (10). Moreover, serum progranulin for Clinical Research, University of Leipzig, Leipzig, Germany; the 4Institute of Laboratory Medicine, was higher in patients with nonalcoholic 5 University of Leipzig, Leipzig, Germany; the Division of Nephrology and KfH Renal Unit, Hospital St. fatty liver disease compared with control Georg, Leipzig, Germany; and the 6Outpatient Nephrology Care Unit, Leipzig, Germany. Corresponding author: Mathias Fasshauer, [email protected]. subjects (11). With these studies taken into Received 1 February 2012 and accepted 25 July 2012. consideration, progranulin appears as a DOI: 10.2337/dc12-0220 novel adipokine upregulated in obesity A slide set summarizing this article is available online. and inducing insulin resistance. J.R. and D.F. contributed equally to this study. © 2013 by the American Diabetes Association. Readers may use this article as long as the work is properly However, no data have been published cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/ thus far concerning progranulin in relation to licenses/by-nc-nd/3.0/ for details. renal function in contrast to other adipokines 410 DIABETES CARE, VOLUME 36, FEBRUARY 2013 care.diabetesjournals.org Richter and Associates including leptin and adiponectin (12,13). diseases, acute generalized inflammation, progranulin serum levels increased with If renal function influenced levels of circu- acute infectious disease, and history of deteriorating renal function, with highest lating progranulin, we would anticipate 1) drug abuse. The study was approved by levels seen in stage 5 of CKD (Table 1). accumulation of the adipokine with dete- the local ethics committee. In contrast,a significant difference in riorating renal function and 2) correlation progranulin concentrations could not be of progranulin with estimated glomerular Assays demonstrated depending on sex (female filtration rate (eGFR) independent of met- Blood samples were taken after an over- 69.9 mg/L [interquartile range 25.4]; male abolic and inflammatory markers. To test night fast. In hemodialysis patients, blood 71.8 mg/L [31.5]), type 2 diabetes (type 2 our hypothesis, we quantified progranu- was obtained just before hemodialysis diabetic patients 71.6 mg/L [29.8]; nondia- lin serum concentrations in 532 patients started. Progranulin (R&D Systems, Min- betic subjects 70.4 mg/L [27.0]), or current with chronic kidney disease (CKD) stages neapolis, MN), high-sensitivity IL-6 smoking (smoker mg/L 75.4 [35.7]; non- 1–5 and correlated this adipokine to clin- (hsIL-6) (R&D Systems, Minneapolis, smoker mg/L 70.5 [26.9]). ical and biochemical markers of renal MN), leptin (Mediagnost, Reutlingen, function, glucose, and lipid metabolism, Germany), and adiponectin (Mediagnost) Univariate correlations as well as inflammation. were determined with enzyme-linked im- Serum progranulin concentrations in all munosorbent assays according to the man- individuals positively and significantly ufacturers’ instructions. Serum creatinine; correlated with WHR, WHtR, serum cre- RESEARCH DESIGN AND fasting glucose; fasting insulin; triglycer- atinine, triglycerides, hsCRP, hsIL-6, and METHODSdFor this cross-sectional ides; total, HDL, and LDL cholesterol, and adiponectin (Table 2). In addition, pro- study, 532 patients (men, n = 305; high-sensitivity C-reactive protein (hsCRP) granulin was negatively and significantly women, n = 227) were recruited by the were measured in a certified laboratory by associated with diastolic blood pressure Department of Endocrinology and Ne- standard methods. (DBP), eGFR, fasting glucose, total choles- phrology, University of Leipzig, as well terol, HDL cholesterol, and LDL cholesterol as from three outpatient Nephrology Statistical analysis (Table 2). Furthermore, in a subset of 351 Care units (KfH Renal Unit, Division of SPSS software, version 18.0 (IBM, Armonk, individuals, circulating progranulin was Nephrology, Hospital St. Georg, and out- NY), was used for all statistical analyses. not significantly associated with fat mass, patient Nephrology Care units, Leipzig). Overall group differences for continuous body fat percentage, lean body mass, or All patients were classified into CKD parameters were assessed by Kruskal- basic metabolic rate assessed by bioelectri- stages 1–5 according to the National Kid- Wallis test followed