MCP-1/CCR2 System as Clinical Biomarker

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Studies assessing the role of MCP-1 as clinical biomarker of DN have been so far disappointing. Despite increased expression of MCP-1 in renal tissue, serum MCP-1 values were comparable in diabetic patients with and without DN in most of the studies and there was no correlation between serum MCP-1 levels and either renal structural abnormalities or monocyte infiltration [77, 113, 114]. Binding to glycosaminoglycan chains on the endothelium is crucial for MCP-1 actions in vivo as it ensures high local MCP-1 concentrations and local MCP-1 immobilization in the kidney may explain the lack of elevations of circulating MCP-1 and the limited value of serum MCP-1 levels as a marker of DN [115]. On the contrary, urinary MCP-1 concentration is increased in patients with DN and  strongly correlates with levels of albuminuria [77, 116, 117]. However, urinary MCP-1 raises in an advanced stage of the complication and is not predictive of either onset or worsening of albuminuria [117]. In a small study performed in macroalbuminuric patients, urinary MCP-1 levels were correlated with the rate of GFR decline [117] and further studies are required to assess the potential clinical relevance of MCP-1 as biomarker of renal function.