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Rishabh Singh,1 James C Watchorn,2 Alexander Zarbock,3 Lui G Forni4,5 1Department of Surgery, Royal Surrey Hospital, Guildford, Surrey, UK; 2Intensive Care Unit, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, UK; 3Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Münster, Germany; 4Critical Care Unit, Royal Surrey Hospital, Guildford, Surrey, UK; 5School of Medicine, Kate Granger Building, University of Surrey, Guildford, UKCorrespondence: Lui G Forni, Email luiforni@nhs.netAbstract: Acute kidney injury (AKI) is a common complication after surgery and the more complex the surgery, the greater the risk. During surgery, patients are exposed to a combination of factors all of which are associated with the development of AKI. These include hypotension and hypovolaemia, sepsis, systemic inflammation, the use of nephrotoxic agents, tissue injury, the infusion of blood or blood products, ischaemia, oxidative stress and reperfusion injury. Given the risks of AKI, it would seem logical to conclude that early identification of patients at risk of AKI would translate into benefit. The conventional markers of AKI, namely serum creatinine and urine output are the mainstay of defining chronic kidney disease but are less suited to the acute phase. Such concerns are compounded in surgical patients given they often have significantly reduced mobility, suboptimal levels of nutrition and reduced muscle bulk. Many patients may also have misleadingly low serum creatinine and high urine output due to aggressive fluid resuscitation, particularly in intensive care units. Over the last two decades, considerable information has accrued with regard to the performance of what was termed “novel” biomarkers of AKI, and here, we discuss the most examined molecules and performance in surgical settings. We also discuss the application of biomarkers to guide patients’ postoperative care.Plain Language Summary: Kidney damage is common after major surgery with a recent study showing almost 1 in 5 patients suffer kidney damage. The usual tests for measuring kidney function are excellent in the outpatient but not so good in acute scenario’s. Therefore, there has been a lot of interest in new markers of kidney damage (so-called novel biomarkers) which perform well acutely and allow earlier detection of damage allowing treatment to be started earlier. This article summarises the currently available biomarkers for use post-operatively and points out the different information that can be achieved by using them routinely.Keywords: acute kidney injury, biomarkers, DKK-3, dickkopf-3, suPAR, soluble urokinase plasminogen activator receptor, IGFBP-7, insulin growth factor binding protein-7 and TIMP-2, tissue inhibitor of metalloproteinases-2, PENK, proenkephalin A 119-159, NGAL, neutrophil gelatinase-associated lipocalin, KIM-1, kidney injury molecule-1, CCL14, chemokine 14

The human Dickkopf (DKK) family includes four main secreted proteins, DKK-1, DKK-2, DKK-3, and DKK-4, as well as the DKK-3 related protein soggy (Sgy-1 or DKKL1). These glycoproteins play crucial roles in various biological processes, and especially modulation of the Wnt signaling pathway. DKK-3 is distinct, with its multifaceted roles in development, stem cell differentiation and tissue homeostasis. Intriguingly, DKK-3 appears to have immunomodulatory functions and a complex role in cancer, acting as either a tumor suppressor or an oncogene, depending on the context. DKK-3 is a promising diagnostic and therapeutic target that can be modulated by epigenetic reactivation, gene therapy and DKK-3-blocking agents. However, further research is needed to optimize DKK-3-based therapies. In this review, we comprehensively describe the known functions of DKK-3 and highlight the importance of context in understanding and exploiting its roles in health and disease. [ABSTRACT FROM AUTHOR]

Vitamin D3 helps to reduce oxidative stress levels, as does Dickkopf-3 (DKK-3) glycoprotein, which is released in the kidney's tubular membrane during stress and helps promote tubulointerstitial fibrosis. The aim is to investigate how vitamin D supplementation affects serum DKK-3 levels and biochemical indicators of renal function in CKD patients in stage III. The study had inclusion criteria for 180 participants of both sexes, aged between 20 and 35 years. They were divided into 3 groups: 60 healthy participants as control, 60 CKD patients in stage III (without vitamin D3 supplements), and 60 others (with three months of 5,000 IU of weekly vitamin D3 supplements). DKK-3 levels in serum, vitamin D3, and parathyroid hormone were examined, and kidney function was tested. Findings indicated a significant increase in levels of DKK-3 serum for patients in the 2 and 3 groups with CKD compared with control. Additionally, outcomes revealed significantly lower DKK-3 (41%) in the third group of patients who took vitamin D compared to the second group (120%) without vitamin D supplements. There was also an improvement in several kidney functions for the third group, and the relationships revealed a significant inverse association between the levels of vitamin D3 and serum DKK3. Also, there is a significant inverse association with urea and creatinine levels; additionally, there is a significant positive association with glomerular filtration rate and calcium. In conclusion, DKK-3 may be a potential biomarker for the development of CKD. Furthermore, vitamin D administration improved kidney function and DKK-3 levels in individuals with stage III CKD. As a result, vitamin D can assist in reducing the development of chronic kidney disease. [ABSTRACT FROM AUTHOR]

Malgré une grande hétérogénéité des situations cliniques, la définition de l'insuffisance rénale aiguë (IRA) est unique et son diagnostic repose essentiellement sur l'augmentation de la créatininémie et/ou la diminution de la diurèse. À l'inverse de l'évolution sur les marqueurs biologiques de l'infarctus du myocarde observée depuis plus de 50 ans, c'est toujours la créatinine "marqueur fonctionnel" qui sert de gold standard biologique pour le diagnostic de l'IRA. Cependant, sous le terme d'IRA, sont regroupées des situations cliniques très hétérogènes d'un point de vue étioIogique, physiopathologique, de durée, d'évolution et d'éventuelles complications associées. Depuis une quinzaine d'années des nouveaux biomarqueurs potentiels sont étudiés et semblent prometteurs. Contrairement à la troponine qui est augmentée dans tous les types d'infarctus du myocarde, ces nouveaux biomarqueurs présentent des sensibilités et spécificités différentes en fonction du type d'IRA, ce qui explique possiblement leur sous-utilisation en pratique courante. Despite a great heterogeneity of clinical situations, the definition of acute kidney injury (AKI) is unique and its diagnosis includes an increase in serum creatinine and/or a decrease in diuresis. Contrary to the evolution of the biological markers of myocardial infarction observed for more than 50 years, it is always the "functional marker" creatinine which serves as the biological gold standard for the diagnosis of AKI. However, under the term of acute renal failure, very heterogeneous clinical situations are grouped together from an etiological, pathophysiological mechanisms, duration, evolution and associated complications. For fifteen/twenty years, new potential biomarkers have been studied and seem promising. Unlike troponin, which is increased in all types of myocardial infarction, these new biomarkers have different sensitivities and specificities depending on the type of AKI, which possibly explains their under-use in current practice. [ABSTRACT FROM AUTHOR]

Background: Activity and chronicity of kidney involvement in ANCA-associated vasculitis (AAV) can be currently reliably evaluated only by kidney biopsy. In this study, we measured a panel of serum and urinary biomarkers collected at the time of kidney biopsy and hypothesized that they could reflect specific histopathological parameters in the biopsy and help to predict prognosis. Methods: We examined a cohort of 45 patients with AAV and 10 healthy controls. Biomarker levels (DKK-3, CD163, EGF, PRO-C6 and C3M) were measured in this study by ELISA. Biopsies were scored with a scoring system for AAV (focal x crescentic x sclerotic x mixed class) and interstitial fibrosis was quantified. Results: Levels of urinary DKK-3, CD163, EGF, PRO-C6 and C3M significantly differed among biopsy classes in AAV, with urinary DKK-3 and PRO-C6 levels being highest in the sclerotic class and lowest in the focal class, urinary CD163 levels highest in the crescentic class and urinary C3M levels highest in the focal class. Moreover, the urinary biomarkers were able to discriminate focal biopsy class from the other classes. Urinary DKK-3, EGF, PRO-C6 and C3M levelsmeasured at the time of biopsy were also significantly related to the extent of fibrosis and to the final kidney function at the end of follow-up. Conclusions: This small pilot study suggests that selected urinary biomarkers of fibrosis and inflammation may reflect changes in the kidney biopsy and be prognostic of kidney outcome in patients with AAV. [ABSTRACT FROM AUTHOR]

The human Dickkopf (DKK) family includes four main secreted proteins, DKK-1, DKK-2, DKK-3, and DKK-4, as well as the DKK-3 related protein soggy (Sgy-1 or DKKL1). These glycoproteins play crucial roles in various biological processes, and especially modulation of the Wnt signaling pathway. DKK-3 is distinct, with its multifaceted roles in development, stem cell differentiation and tissue homeostasis. Intriguingly, DKK-3 appears to have immunomodulatory functions and a complex role in cancer, acting as either a tumor suppressor or an oncogene, depending on the context. DKK-3 is a promising diagnostic and therapeutic target that can be modulated by epigenetic reactivation, gene therapy and DKK-3-blocking agents. However, further research is needed to optimize DKK-3-based therapies. In this review, we comprehensively describe the known functions of DKK-3 and highlight the importance of context in understanding and exploiting its roles in health and disease.

BackgroundActivity and chronicity of kidney involvement in ANCA-associated vasculitis (AAV) can be currently reliably evaluated only by kidney biopsy. In this study, we measured a panel of serum and urinary biomarkers collected at the time of kidney biopsy and hypothesized that they could reflect specific histopathological parameters in the biopsy and help to predict prognosis.MethodsWe examined a cohort of 45 patients with AAV and 10 healthy controls. Biomarker levels (DKK-3, CD163, EGF, PRO-C6 and C3M) were measured in this study by ELISA. Biopsies were scored with a scoring system for AAV (focal x crescentic x sclerotic x mixed class) and interstitial fibrosis was quantified.ResultsLevels of urinary DKK-3, CD163, EGF, PRO-C6 and C3M significantly differed among biopsy classes in AAV, with urinary DKK-3 and PRO-C6 levels being highest in the sclerotic class and lowest in the focal class, urinary CD163 levels highest in the crescentic class and urinary C3M levels highest in the focal class. Moreover, the urinary biomarkers were able to discriminate focal biopsy class from the other classes. Urinary DKK-3, EGF, PRO-C6 and C3M levels measured at the time of biopsy were also significantly related to the extent of fibrosis and to the final kidney function at the end of follow-up.ConclusionsThis small pilot study suggests that selected urinary biomarkers of fibrosis and inflammation may reflect changes in the kidney biopsy and be prognostic of kidney outcome in patients with AAV.

The human Dickkopf (DKK) family includes four main secreted proteins, DKK-1, DKK-2, DKK-3, and DKK-4, as well as the DKK-3 related protein soggy (Sgy-1 or DKKL1). These glycoproteins play crucial roles in various biological processes, and especially modulation of the Wnt signaling pathway. DKK-3 is distinct, with its multifaceted roles in development, stem cell differentiation and tissue homeostasis. Intriguingly, DKK-3 appears to have immunomodulatory functions and a complex role in cancer, acting as either a tumor suppressor or an oncogene, depending on the context. DKK-3 is a promising diagnostic and therapeutic target that can be modulated by epigenetic reactivation, gene therapy and DKK-3-blocking agents. However, further research is needed to optimize DKK-3-based therapies. In this review, we comprehensively describe the known functions of DKK-3 and highlight the importance of context in understanding and exploiting its roles in health and disease.

Background: Prostate cancer (PCa) is a frequent malignant tumor worldwide with high morbidity along with mortality. MicroRNAs (miRNAs) have been identified as key posttranscriptional modulators in diverse cancers. Herein, we purposed to explore the impacts of miR-363-3p on PCa growth, migration, infiltration along with apoptosis., Methods: The expressions of miR-363-3p along with Dickkopf 3 (DKK3) were assessed in clinical PCa specimens. We adopted the PCa cell line PC3 and transfected it using miR-363-3p repressors or mimic. The relationship of miR-363-3p with DKK3 was verified by a luciferase enzyme reporter assay. Cell viability along with apoptosis were determined by MTT assay coupled with flow cytometry analysis. Cell migration along infiltration were detected via wound healing, as well as Transwell assays. The contents of DKK3, E-cadherin, vimentin along with N-cadherin were analyzed via Western blotting accompanied with qRT-PCR., Results: MiR-363-3p was found to be inversely associated with the content of DKK3 in clinical PCa specimens. Further investigations revealed that DKK3 was miR-363-3p's direct target. Besides, overexpression of miR-363-3p decreased the contents of DKK3, promoted cell viability, migration coupled with infiltration, and reduced cell apoptosis, while silencing of miR-363-3p resulted in opposite influence. Upregulation of miR-363-3p diminished E-cadherin contents but increased vimentin along with N-cadherin protein contents in PC3 cells; in contrast, miR-363-3p downregulation produced the opposite result., Conclusion: Our study indicates that miR-363-3p promotes PCa growth, migration coupled with invasion while dampening apoptosis by targeting DKK3., (© 2022 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals LLC.)

Gastric cancer is a prevalent yet heterogeneous disease which ranks as the fifth most common cancer in the world. Dietary habit, genetic background, Helicobacter Pylori infections were the risk factors of gastric cancer. MicroRNA miR-425 is highly expressed in gastric cancer, but little attention has been devoted to the mechanism of miR-425 in tumorigenesis. This study aim to investigate the role of miR-425 in gastric cancer.The expression of miR-425 and Dickkopf-related protein-3(DKK-3) were analyzed by qRT-PCR. Gastric cell line BGC-823 and SGC-7901 were transfected miR-425 inhibitors or NC. Then, cell viability was determined by CCK-8, cell apoptosis and cell cycle were assessed by flow cytometer. Cell migration and cell invasion were analyzed by wound healing and trans-well assays. Luciferase reporter assay was conducted to assess the correlation between miR-425 and DKK-3. Downstream regulators, such as p-ASK1 and p-JNK, were analysis by western blot.Compared with normal gastric epithelium cell line, miR-425 was obviously upregulated in gastric cancer cell lines. MiR-425 inhibitor suppressed the cell viability, cell migration and cell invasion. The Luciferase assay data identified that DKK-3 is a target of miR-425. While miR-425 could lower the expression of DKK-3 which mediate tumorigenesis in a certain way.