Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015, 159(3):352-359 | DOI: 10.5507/bp.2015.018

Fetuin-A (AHSG) and its usefulness in clinical practice. Review of the literature

Anna Maria Dabrowskaa, Jerzy Stanislaw Taracha, Beata Wojtysiak-Dumab, Dariusz Dumac
a Department of Endocrinology, Medical University of Lublin, Poland
b Department of Biochemical Diagnostics, Medical University of Lublin, Poland
c Department of Laboratory Diagnostics, Medical University of Lublin, Poland

Background: Fetuin-A, also called Alpha 2-Heremans Schmid Glycoprotein, is a multifunctional plasma agent what has been proven in animal and human studies. It plays a role as a physiological inhibitor of insulin receptor tyrosine kinase associated with insulin resistance and a negative acute phase reactant. It also regulates bone remodeling and calcium metabolism being an important inhibitor of calcium salt precipitation and vascular calcifications.

Methods: PubMed database was searched for articles from 2002 up to December 2014 to identify the role of fetuin-A in the pathogenesis of selected internal diseases.

Results: Due to secretion of fetuin-A mainly by the liver, it may be a marker of liver function and predictor of mortality in patients with cirrhosis and hepatocellular cancer. The associations between high fetuin-A and metabolic syndrome as well as its hepatic manifestation- nonalcoholic fatty liver disease and atherogenic lipid profile have been well proven. However, fetuin-A relation with BMI is not so clear. Contrary to few reports, many authors suggest that fetuin-A may be an independent risk factor for type 2 diabetes and marker of diabetic complications. Close associations of high and low fetuin-A concentrations with cardiovascular diseases and mortality risk have been reported which is explained by differences in analyzed populations, stages of atherosclerosis and calcifications, coexistence of type 2 diabetes or kidney dysfunction and different main pathways of fetuin-A actions in various diseases.

Conclusions: Fetuin-A has a diagnostic potential as a biomarker for liver dysfunction, cardiovascular diseases and disorders associated with metabolic syndrome.

Keywords: fetuin-A, diabetes, obesity, cardiovascular disease, atherosclerosis

Received: October 21, 2014; Accepted: April 10, 2015; Prepublished online: April 24, 2015; Published: September 30, 2015  Show citation

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Dabrowska, A.M., Tarach, J.S., Wojtysiak-Duma, B., & Duma, D. (2015). Fetuin-A (AHSG) and its usefulness in clinical practice. Review of the literature. Biomedical papers159(3), 352-359. doi: 10.5507/bp.2015.018
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References

  1. Wojtysiak-Duma B, Malecha Jêdraszek A, Burska A, Duma D, Donica H. Serum fetuin-A levels in patients with type 2 diabetes mellitus. Ann UMCS Sect DDD 2010;2(14):93-9.
  2. Kettler M, Bongartz P, Westenfeld R, Wildberger JE, Mahnken AH, Böhm R, Metzger T, Wanner C, Jahnen-Dechent W, Floege J. Association of low fetuin-A (AHSG) concentration in serum with cardiovascular mortality in patients on dialysis: a cross-sectional study. The Lancet 2003;361(9360):827-33. Go to original source...
  3. Xu Y, Xu M, Bi Y, Song A, Huang Y, Liu Y, Wu Y, Chen Y, Wang W, Li X, Ning G. Serum fetuin-A is corretaled with metabolic syndrome in middle-aged and elderly Chinese. Atherosclerosis 2011;216(1):180-6. Go to original source... Go to PubMed...
  4. Jahnen-Dechent W, Heiss A, Schäfer C, Ketteler M. Fetuin-A regulation of calcified matrix metabolism. Circ Res 2011;108(12):1494-9. Go to original source... Go to PubMed...
  5. Stefan N, Hennige AM, Steiger H, Machann J, Schick F, Kröber SM, Machicao F, Fritsche A, Häring HU. α2-Heremans-Schmid Glycoprotein/Fetuin-A is associated with insulin resistance and fat accumulation in the liver in humans. Diabetes Care 2006;29(4):853-7. Go to original source... Go to PubMed...
  6. Kaushik SV, Plaisance EP, Kim T, Huang EY, Mahurin AJ, Grandjean PW, Mathews ST. Extended-release niacin decreases serum fetuin-A concentrations in individuals with metabolic syndrome. Diabetes Metab Res Rev 2009;25(5):427-4. Go to original source... Go to PubMed...
  7. Singh M, Sharma PK, Garg VK, Mondal SC, Singh AK, Kumar N. Role of fetuin-A in atherosclerosis associated with diabetic patients. J Pharm Pharmacol 2012;64(12):1703-8. Go to original source... Go to PubMed...
  8. Ix JH, Shlipak MG, Brandenburg VM, Ali S, Ketteler M, Whooley MA. Association between human fetuin-A and the metabolic syndrome: data from the Heart and Soul Study. Circulation 2006;113(14):1760-7. Go to original source... Go to PubMed...
  9. Stefan N, Fritsche A, Weikert C, Boeing H, Joost HG, Häring HU, Schulze MB. Plasma fetuin-A levels and the risk of type 2 diabetes. Diabetes 2008;57(10):2762-7. Go to original source... Go to PubMed...
  10. Dasgupta S, Bhattacharya S, Biswas A, Majumdar SS, Mukhopadhyay S, Ray S, Bhattacharya S. NF-kappaB mediates lipid-induced fetuin-A expression in hepatocytes that impairs adipocyte function effecting insulin resistance. Biochem J 2010;429(3):451-62. Go to original source... Go to PubMed...
  11. Chen HY, Chiu YL, Hsu SP, Pai MF, Lai CF, Peng YS, Kao TW, Hung KY, Tsai TJ, Wu KD. Association of serum fetuin-A with truncal obesity and dyslipdemia in non-diabetic hemodialysis patients. Eur J Endocrinol 2009;160(55):777-83. Go to PubMed...
  12. Vörös K, Gráf L Jr, Prohászka Z, Gráf L, Szenthe P, Kaszás E, Böröcz Z, Cseh K, Kalabay L. Serum fetuin-A in metabolic and inflammatory pathways in patients with myocardial infarction. Eur J Clin Invest 2011;41(7):703-9. Go to original source... Go to PubMed...
  13. Ismail NA, Ragab S, Abd El Dayem SM, Elbaky AA, Salah N, Hamed M, Assal H, Koura H. Fetuin-A levels in obesity: differences in relation to metabolic syndrome and correlation with clinical and laboratory variables. Arch Med Sci 2012;8(5):826-3. Go to original source... Go to PubMed...
  14. Reinehr T, Roth CL. Fetuin-A and its relation to metabolic syndrome and fatty liver disease in obese children before and after weight loss. J Clin Endocrinol Metab 2008;93(11): 4479-85. Go to original source... Go to PubMed...
  15. Andersen G, Burgdorf KS, Sparso T, Borch-Johnsen K, Jørgensen T, Hansen T, Pedersen O. AHSG tag single nucleotide polymorphisms associate with type 2 diabetes and dyslipidemia. Diabetes 2008;57(5):1427-32. Go to original source... Go to PubMed...
  16. Lavebratt C, Dungner E, Hoffstedt J. Polymorphism of the AHSG gene is associated with increased adipocyte ß2-adrenoceptor function. J Lipid Res 2005;46(10):2278-81. Go to original source... Go to PubMed...
  17. Siddiq A, Lepretre F, Hercberg S, Froguel P, Gibson F. A synonymous coding polymorphism in the α2-Heremans-Schmid Glycoprotein gene is associated with type 2 diabetes in French Caucasians. Diabetes 2005;54(8):2477-81. Go to original source... Go to PubMed...
  18. Brix JM, Stingl H, Hollerl F, Schernthaner GH, Kopp HP, Schernthaner G. Elevated Fetuin-A concentrations in morbid obesity decrease after dramatic weight loss. J Clin Endocrinol Metab 2010;95(11):4877- 81. Go to original source... Go to PubMed...
  19. Lavebratt C, Wahlqvist S, Nordfors L, Hoffstedt J, Arner P. AHSG variant is associated with leaness among Swedish men. Hum Genet 2005;117(1):54-60. Go to original source... Go to PubMed...
  20. Carvalho BM, Abdalla Saad MJ. Influence of gut microbiota on subclinical inflammation and insulin resistance. Mediators Inflamm 2013;2013:986734. Go to original source... Go to PubMed...
  21. Ix JH, Wassel CL, Kanaya AM, Vittinghoff E, Johnson KC, Koster A, Cauley JA, Harris TB, Cummings SR, Shlipak MG; Health ABC Study. Fetuin-A and incident diabetes mellitus in older persons. JAMA 2008;300(2):182-8. Go to original source... Go to PubMed...
  22. Mathews ST, Singh GP, Ranalletta M, Cintron VJ, Qiang X, Goustin AS, Jen KL, Charron MJ, Jahnen-Dechent W, Grunberger G. Improved insulin sensitivity and resistance to weight gain mice null for the AHSG gene. Diabetes 2002;51(8):2450-8. Go to original source... Go to PubMed...
  23. Mathews ST, Rakhade S, Zhou X, Parker GC, Coscina DV, Grunberger G. Fetuin-null mice are protected against obesity and insulin resistance associated with aging. Biochem Biophys Res Commun 2006;350(2):437-43. Go to original source... Go to PubMed...
  24. Ix JH, Sharma K. Mechanism linking obesity, chronic kidney disease and fatty liver disease: the roles of fetuin-A, adiponectin and AMPK. J Am Soc Nephrol 2010;21(3):406-12. Go to original source... Go to PubMed...
  25. Mabalirajan U, Ghosh B. Mitochondrial dysfunction in metabolic syndrome and asthma. J Allergy (Cairo) 2013;2013:340476. Go to original source... Go to PubMed...
  26. Erdmann J, Salmhofer H, Knauß A, Mayr M, Wagenpfeil S, Sypchenko O, Luppa P, Schusdziarra V. Relationship of fetuin-A levels to weight-dependent insulin resistance and type 2 diabetes mellitus. Regul Pept 2012;178(1-3):6-10. Go to original source... Go to PubMed...
  27. Ix JH, Chertow GM, Shlipak MG, Brandenburg VM, Ketteler M, Whooley MA. Fetuin-A and kidney function in persons with coronary artery disease- data from the heart and soul study. Nephrol Dial Transplant 2006;21(8):2144-51. Go to original source... Go to PubMed...
  28. Hennige AM, Staiger H, Wicke C, Machicao F, Fritsche A, Häring HU, Stefan N. Fetuin-A induces cytokine expression and suppresses adiponectin production. PLoS One 2008;3(3):e1765. Go to original source... Go to PubMed...
  29. Obuchi A, Adachi H, Enomoto M, Fukami A, Kumagai E, Nakamura S, Yoshimura A, Nohara Y, Nakao E, Umeki Y, Fukumoto Y, Imaizumi T. High plasma fetuin-A levels are associated with metabolic syndrome among males but not females in a Japanese general population. Diabetes Res Clin Pract 2014;106(1):128-35. Go to original source... Go to PubMed...
  30. Dahlman I, Eriksson P, Kaaman M, Jiao H, Lindgren CM, Kere J, Arner P. α2-Heremans-Schmid glycoprotein gene polymorphisms are associated with adipocyte insulin action. Diabetologia 2004;47(11):1974-9. Go to original source... Go to PubMed...
  31. Kalabay L, Szalay F, Nemesanszky E, Telegdy L, Jakab L, Romies L. Decreased serum α2-HS-glycoprotein concentration in patients with primary biliary cirrhosis. J Hepatol 1997;26(6):1426-7. Go to original source... Go to PubMed...
  32. Kalabay L, Jakab L, Prohászka Z, Füst G, Benkö Z, Telegdy L, Lörincz Z, Závodszky P, Arnaud P, Fekete B. Human fetuin/alpha2HS-glycoprotein level as a novel indicator of liver cell function and short-term mortality in patients with liver cirrhosis and liver cancer. Eur J Gastroenterol Hepatol 2002;14(4):389-94. Go to original source... Go to PubMed...
  33. Daveau M, Davrinche C, Juten N, Hiron M, Arnaud P, Lebreton JP. The synthesis of human a2-HS glycoprotein is down-regulated by cytokines in hepatoma HepG2 cells. FEBS Lett 1988;241(1-2):191-4. Go to original source... Go to PubMed...
  34. Daveau M, Davrinche C, Djelassi N, Lemetayer J, Julen N, Hiron M, Arnaud P, Lebreton JP. Partial hepatectomy and mediators of inflammation decrease the expression of liver ɑ2-HS glycoprotein gene in rats. FEBS Lett 1990;273(1-2):79-81. Go to original source... Go to PubMed...
  35. Yilmaz Y, Yonal O, Kurt R, Ari F, Oral AY, Celikel CA, Korkmaz S, Ulukaya E, Ozdogan O, Imeryuz N, Avsar E, Kalayci C. Serum fetuin A/α2HS-glycoprotein levels in patients with non-alcoholic fatty liver disease: relation with liver fibrosis. Ann Clin Biochem 2010;47(Pt 6):549-53. Go to original source... Go to PubMed...
  36. Chen HY, Lin CC, Chiu YL, Hsu SP, Pai MF, Yang JY, Peng YS. Serum fetuin A and chemerin levels correlate with hepatic steatosis and regional adiposity in maintenance hemodialysis patients. PLoS One 2012;7(7):e38415. Go to original source... Go to PubMed...
  37. Lebensztejn DM, Bia³okoz-Kalinowska I, K³usek-Oksiuta M, Tarasów E, Wojtkowska M, Kaczmarski M. Serum fetuin A concentration is elevated in children with non-alcoholic fatty liver disease. Adv Med Sci 2014;59(1):81-4. Go to original source... Go to PubMed...
  38. Chhabra L, Liti B, Kuraganti G, Kaul S, Trivedi N. Challenges in the management of type 2 diabetes mellitus and cardiovascular risk factors in obese subjects: what is the evidence and what are the myths? Int J Endocrinol 2013;2013:856793. Go to original source... Go to PubMed...
  39. Ix JH, Biggs ML, Mukamal KJ, Kizer JR, Zieman SJ, Siscovick DS, Mozzaffarian D, Jensen MK, Nelson L, Ruderman N, Djousse L. Association of fetuin-A with incident diabetes mellitus in community-living older adults: the cardiovascular health study. Circulation 2012;125(19):2316-22. Go to original source... Go to PubMed...
  40. Stefan N, Sun Q, Fritsche A, Machann J, Schick F, Gerst F, Jeppesen C, Joost HG, Hu FB, Boeing H, Ullrich S, Häring HU, Schulze MB. Impact of the adipokine adiponectin and the hepatokine fetuin-A on the development of type 2 diabetes: prospective cohort- and cross-sectional phenotyping studies. PLoS One 2014;9(3):e92238. Go to original source... Go to PubMed...
  41. Mehrotra R, Westenfeld R, Christenson P, Budoff M, Ipp E, Takasu J, Gupta A, Norris K, Ketteler M, Adler S. Serum fetuin-A in nondialyzed patients with diabetic nephropathy: relationship with coronary artery calcification. Kidney Int 2005;67(3):1070-7. Go to original source... Go to PubMed...
  42. Lorant DP, Grujicic M, Hoebaus C, Brix JM, Hoellerl F, Schernthaner G, Koppensteiner R, Schernthaner GH. Fetuin-A levels are increased in patients with type 2 diabetes and peripheral arterial disease. Diabetes Care 2011;34(1):156-61. Go to original source... Go to PubMed...
  43. Eraso LH, Ginwala N, Quasim AN, Mehta NN, Dlugash R, Kapoor S, Schwartz S, Schutta M, Iqbal N, Mohler ER 3rd, Reilly MP. Association of lower plasma fetuin-A levels with peripheral arterial disease in type 2 diabetes. Diabetes Care 2010;33(2):408-10. Go to original source... Go to PubMed...
  44. Jung CH, Kim BY, Kim CH, Kang SK, Jung SH, Mok JO. Associations of serum fetuin-A levels with insulin resistance and vascular complications in patients with type 2 diabetes. Diab Vasc Dis Res 2013;10(5):459-67. Go to PubMed...
  45. Ohira T, Iso H. Cardiovascular disease epidemiology in Asia. Circ J 2013;77(7):1646-52. Go to original source... Go to PubMed...
  46. Weikert C, Stefan N, Schultze MB, Pischon T, Berger K, Joost HG, Häring HU, Boeing H, Fritsche A. Plasma fetuin-A levels and the risk of myocardial infarction and ischemic stroke. Circulation 2008;118(24):2555-62. Go to original source... Go to PubMed...
  47. Mori K, Emoto M, Araki T, Yokoyama H, Teramura M, Lee E, Motoyama K, Koyama H, Shoji T, Inaba M, Nishizawa Y. Association of serum fetuin-A with carotid arterial stiffness. Clin Endocrinol (Oxf) 2007;66(2):246-50. Go to original source... Go to PubMed...
  48. Zhao ZW, Lin CG, Wu LZ, Luo YK, Fan L, Dong XF, Zheng H. Serum fetuin-A levels are associated with the presence and severity of coronary artery disease in patients with type 2 diabetes. Biomarkers 2013;18(2):160-4. Go to original source... Go to PubMed...
  49. Lim P, Collet JP, Moutereau S, Guigui N, Mitchell-Heggs L, Loric S, Bernard M, Benhamed S, Montalescot G, Randé JL, Guéret P. Fetuin-A is an independent predictor of death after ST-elevation myocardial infarction. Clin Chem 2007;53(10):1835-40. Go to original source... Go to PubMed...
  50. Bilgir O, Kebapcilar L, Bilgir F, Bozkaya G, Yildiz Y, Pinar P, Tastan A. Decreased serum fetuin-A levels are associated with coronary artery diseases. Intern Med 2010;49(13):1281-5. Go to original source... Go to PubMed...
  51. Ix JH, Katz R, de Boer IH, Kestenbaum BR, Peralta CA, Jenny NS, Budoff M, Allison MA, Criqui MH, Siscovick D, Shlipak MG. Fetuin-A is inversely associated with coronary artery calcification in community-living persons: the Multi-Ethnic Study of Atherosclerosis. Clin Chem 2012;58(5):887-95. Go to original source... Go to PubMed...
  52. Hermans MM, Brandenburg V, Ketteler M, Kooman JP, van der Sande FM, Boeschoten EW, Leunissen KM, Krediet RT, Dekker FW; Netherlands cooperative study on the adequacy of Dialysis (NECOSAD). Association of serum fetuin-A levels with mortality in dialysis patients. Kidney Int 2007;72(2):202-7. Go to original source... Go to PubMed...
  53. Roos M, Oikonomou D, von Eynatten M, Luppa PB, Heemann U, Lutz J, Baumann M, Nawroth PP, Bierhaus A, Humpert PM. Associations of fetuin-A levels with vascular disease in type 2 diabetes patients with early diabetic nephropathy. Cardiovasc Diabetol 2010;9:48. Go to original source... Go to PubMed...
  54. Laughlin GA, Cummins KM, Wassel CL, Daniels LB, Ix JH. The association of fetuin-A with cardiovascular disease mortality in older community-dwelling adults: the Rancho Bernardo study. J Am Coll Cardiol 2012;59(19):1688-96. Go to original source... Go to PubMed...
  55. Jensen MK, Bartz TM, Mukamal KJ, Djoussé L, Kizer JR, Tracy RP, Zieman SJ, Rimm EB, Siscovick DS, Shlipak M, Ix JH. Fetuin-A, type 2 diabetes, and risk of cardiovascular disease in older adults: the cardiovascular health study. Diabetes Care 2013;36(5):1222-8. Go to original source... Go to PubMed...
  56. Emoto M, Mori K, Lee E, Kawano N, Yamazaki Y, Tsuchikura S, Morioka T, Koyama H, Shoji T, Inaba M, Nishizawa Y. Fetuin-A and atherosclerotic calcified plaque in patients with type 2 diabetes mellitus. Metabolism 2010;59(6):873-8. Go to original source... Go to PubMed...